Molecular pathogenesis of oral submucous fibrosis - a collagen metabolic disorder

Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management

Oral Submucous fibrosis (OSMF) has traditionally been described as “a chronic, insidious, scarring disease of the oral cavity, often with involvement of the pharynx and the upper esophagus”. Millions of individuals are affected, especially in South and South East Asian countries. The main risk factor is areca nut chewing. Due to its high morbidity and high malignant transformation rate, constant efforts have been made to develop effective management. Despite this, there have been no significant improvements in prognosis for decades. This expert opinion paper updates the literature and provides a critique of diagnostic and therapeutic pitfalls common in developing countries and of deficiencies in management. An inter-professional model is proposed to avoid these pitfalls and to reduce these deficiencies.

Role of angiogenesis in oral submucous fibrosis using vascular endothelial growth factor and CD34: An immunohistochemical study

Background

Oral submucous fibrosis (OSF) is an insidious, chronic, disabling disease, in which there is lack of perfusion due to reduced level of the vasculature and this is said to be responsible for the epithelial atrophy seen in OSF. The degree of vasculature of the affected mucosa and its effects on the epithelial thickness remains controversial till date.

Aims

This study attempts to analyze the role of angiogenesis in OSF and its progression using vascular endothelial growth factor (VEGF) and CD34 markers.

Materials and Methods

The study samples for the present study comprised of 10 cases each of early OSF, moderately advanced, advanced OSF, and 10 cases of normal oral mucosa were used as controls. All the cases were subjected to immunohistochemical staining with VEGF and CD34 markers.

Results

Among the different grades of OSF, we did not find any noticeable difference in VEGF expression although we found a upregulation in microvessel density (CD34) in early and moderately advanced OSF followed by a downregulation in advanced OSF.

Conclusions

As the disease progresses, there is an increased production of the extracellular matrix component (collagen I and II and fibronectin) and results in fibrosis. Subsequently, it leads to the reduction in the level of corium vascularity and results in hypoxia which ultimately causes reduction and constriction of the vascular channels. This sequence of events alerts us to the relevance of early disease diagnosis and management in an irreversible pathology such as OSF.

Comparative Evaluation of role of Lysyl oxidase gene (LOXG473A) expression in pathogenesis and malignant transformation of Oral Submucous Fibrosis

Background

Identification and comparison of gene expression of Lysyl oxidase (LOX) in oral submucous fibrosis and controls and to determine its role in Pathogenesis of Oral submucous fibrosis.

Material and Methods

Of total sample size (n=127), the whole blood sample were collected from case and control group in citrate vial. It is centrifused and stored at -800C. We collected and isolated RNA from blood of case group (n=127) and age and sex matched control group (n=127) recruited on the basis of inclusion criteria. The cDNA was prepared for 127 samples which were processed for gene expression of Lysyl oxidase (LOX) in relation to housekeeping genes (Beta actin and 18srRNA) and its role in pathogenesis of Oral submucous fibrosis.

Results

In relative expression (Normalized ratio),relatively 11 cases shown down-regulation of lysyl oxidase gene while 27 cases shows up-regulation of lysyl oxidase gene while in 89 cases there were no regulation i.e expression of lysyl oxidase gene in case group was of same degree of control. In non-relative expression results (Non-normalized ratio), the 38 cases shown down regulation of LOX gene while in 53 cases, it was up-regulated however in remaining 36 cases there was neither up-regulation nor down-regulation of Lysyl oxidase gene i.e the expression of LOX gene is null.

Conclusions

In oral submucous fibrosis, the expression of Lysyl oxidase gene is mixed type i.e either it will down regulate/upregulate or there will be no expression at all comparatively. However in majority of cases the upregulation of lysyl oxidase is relatively more common than down-regulation or non expression of Lysyl oxidase gene.

Key words:Oral submucous fibrosis, lysyl oxidase, betel nut, premalignant disorders.

Oral submucous fibrosis in Asian countries

Oral submucous fibrosis (OSF) is a chronic, insidious, and progressive oral mucosal disease that affects entire oral cavity and sometimes pharynx. This oral potentially malignant disorder has a high rate of malignant transformation (7%-30%) to oral squamous cell carcinoma (OSCC), posing global problems for public health. Due to enormous efforts dedicated to this disease in the past decades, there have been significant advances in identification of its etiology and pathogenesis as well as development of corresponding therapeutic approaches, in spite of several challenges. This study reviewed the existing literature concerning OSF in Asian countries, encompassing its etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, and treatments. For improving treatment of OSF, the multifactorial etiology analysis, incorporation of effective molecular pathways, cytokines and cells for mechanism illustration, and integration of multidisciplinary modalities were also expounded to guide future research and clinical practice.

Morphometric Evaluation of Soft Palate in OSMF Patients Using Cephalometrics

Oral submucous fibrosis (OSF) is a chronic disease and a well-recognized potentially malignant condition of the oral cavity characterized by inflammation and a progressive fibrosis of the lamina propria and deeper connective tissues. To study the morphology of soft palate in different stages of OSF on digital lateral cephalogram. To compare the changes in morphology of soft palate in OSF patients with control. The study was conducted from 2017 to 2018 on 217 patients with their age ranging from 17 to 60 years. All patients detailed clinical examination and history was taken and cephalometric evaluation was done. Type I (51.14%) was found to be the most common in OSF group followed by type II (21.86%) and type VI (13.64%). The present study highlighted the variable radiographic appearances of the soft palate on lateral cephalograms with type I as most common morphology. Cephalometric analysis is one of the most commonly accepted techniques for evaluating the soft palate in both normal individuals and in those with cleft lip and palate.

Proposed clinical definition for oral submucous fibrosis

Oral Submucous Fibrosis (OSMF) is an insidious, chronic, complex, crippling, debilitating, irreversible, progressive, scarring, potentially malignant and collagen metabolic disorder, induced by a known carcinogen areca nut; wherein the oral mucosa, and occasionally the pharynx and esophagus is subjected to various pathological changes with significant clinical manifestations at different stages of progression, leading to functional morbidity; and with a risk of malignant transformation in the overlying epithelium. Although the condition is mainly diagnosed based on classic clinical manifestations, the commonly used existing definition for oral submucous fibrosis is primarily based on histological features. The authors have conducted extensive clinical research studies on OSMF and intends to propose a new clinical definition as 'a debilitating, progressive, irreversible collagen metabolic disorder induced by chronic chewing of areca nut and its commercial preparations; affecting the oral mucosa and occasionally the pharynx and esophagus; leading to mucosal stiffness and functional morbidity; and has a potential risk of malignant transformation.' Thus, a new clinical definition is put forward so as to assist the academicians, researchers and clinicians in terming and grouping this disease according to its clinical and biological behaviour for its subsequent management.

Efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis: A meta-analysis of randomized controlled trials

BACKGROUND

This study was performed to systematically review the efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis.

METHODS

We searched 9 databases: Web of Science, PubMed, Medline, EBSCO, Embase, The Cochrane Library, WanFang Data, the China National Knowledge Infrastructure (CNKI), and Chinese Scientific Journals Full-text Database (VIP). Randomized controlled trials were collected to study the treatment of oral submucous fibrosis by S miltiorrhiza injection combined with steroids. Each database was searched from inception to November 2018. RevMan 5.3 software was used for the meta-analysis.

RESULTS

In total, 13 randomized controlled trials involving 1190 patients were included. The results of the meta-analysis showed that compared with conventional treatment, S miltiorrhiza injection combined with steroids could significantly increase the maximal mouth opening [mean difference (MD), 0.23; 95% confidence interval (CI), 0.16-0.30; P <.0001], decrease the oral mucosal lesion area (MD, -1.35; 95% CI, -2.46 to -0.25; P = .02), improve the subjective symptom burning sensation (MD, -0.77; 95% CI, -1.38 to -0.16; P = .01), and reduce adverse drug reactions (risk ratio, 0.27; 95% CI, 0.14-0.49; P <.0001).

CONCLUSIONS

The results of this meta-analysis from current evidence showed that compared with conventional treatment, S miltiorrhiza injection combined with steroid could significantly improve the maximal mouth opening and the subjective symptom burning sensation as well as decrease the oral mucosal lesion area without increasing adverse effects.

Oral Submucous Fibrosis: A Review on Etiopathogenesis, Diagnosis, and Therapy

Oral submucous fibrosis (OSF) is characterized by abnormal collagen deposition. It is a precancerous disorder and transforms into a malignant tumor in 1.5–15% of all cases. Symptoms include submucous fibrosis, ulceration, xerostomia, a burning sensation, and restricted mouth opening. All of these greatly interfere with patient quality of life. The present review introduces OSF from a molecular perspective and summarizes what is known about its underlying mechanisms, diagnostic biomarkers, and therapeutic interventions. In addition to the aggressive treatment of OSF, its prevention is also important. Future research should, therefore, focus on improving the oral health literacy of the patients susceptible to OSF.

Efficacy of Prednisolone Mouthwash in Management of Grade III Oral Submucous Fibrosis: A Newer Drug Regimen

Introduction

This clinical randomized controlled trial evaluates the effectiveness of prednisolone mouthwash as a treatment modality for moderately advanced cases of oral submucous fibrosis.

Materials and Method

Sixty-four patients were enrolled for the study and randomized into two groups (n = 32 in each group). The experimental group was treated with prednisolone mouthwash and antioxidant capsule as per GDCH Nagpur protocol, and control group was treated with antioxidant capsule only. The primary outcome variables were interincisal mouth opening, burning sensation, and recurrent ulceration. Clinical responses were obtained at the time of the allocation, at 1, 3, 6, and 9 months into the intervention, and 6 months thereafter.

Results

The average increased mouth opening achieved was 10.46 mm (p < 0.5) in group A (experimental group) and only 1.04 mm (p < 0.5) mm in group B (control group). In addition, there was a significant difference in relief of burning sensation and recurrent ulceration. Relief of burning sensation and recurrent ulceration was within 12.81 and 10.93 days, respectively, in group A when compared to group B which was within 21.56 and 20.06 days, respectively.

Conclusion

We conclude that in our trial, prednisolone mouthwash with antioxidants was seen to be efficacious, safe, and reliable in the management of oral submucous fibrosis.

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan

OBJECTIVE

Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity.

SETTING

This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan.

PARTICIPANTS

In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument.

RESULTS

Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20).

CONCLUSION

Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

miR-1246 as a therapeutic target in oral submucosa fibrosis pathogenesis

BACKGROUND/PURPOSE

Oral submucous fibrosis (OSF) is a precancerous condition of oral cancer with a complex etiology. Our previous work has demonstrated that non-coding RNA miR-1246 contributes to the cancer stemness of oral cancer. In the current study, we sought to investigate the effect of the inhibition of miR-1246 on the oral fibrogenesis.

METHODS

The expression levels of miR-1246 in OSF tissues and fibrotic buccal mucosal fibroblasts (fBMFs) were examined by qRT-PCR. Collagen gel contraction and migration assays were conducted to evaluate the myofibroblast activities. The relationship between miR-1246 and type I collagen was assessed and the protein expression of type I collagen was determined by Western blot.

RESULTS

MiR-1246 expression was upregulated in both OSF specimen and fBMFs compared to the normal counterparts. Inhibition of miR-1246 successfully suppressed the myofibroblast activities, including collagen gel contractility and migration capacity. Moreover, the expression of miR-1246 was positively correlated with type I collagen and the expression of type I collagen was abrogated by repression of miR-1246.

CONCLUSION

MiR-1246 is not only critical to the maintenance of oral stemness but also important to the activation of myofibroblasts. Our results showed that miR-1246 is positively associated with the type I collagen, which may be a downstream effector of miR-1246 and responsible for the fibrosis effect on fBMFs.

Histochemical and Immunohistochemical Analysis of Collagen Fibers and Microvascular Density in Various Grades of Oral Submucous Fibrosis

Background and Objective:

This study was aimed to evaluate the collagen fibers qualitatively and its correlation with microvascular density in various grades of oral submucous fibrosis (OSMF).

Material and Methods:

The present study comprised of total 40 cases of oral submucous fibrosis. Picrosirius red staining was done on all the specimens’ sections. They were analyzed for the colour and orientation of collagen fibers. Morphometric measurements were done using image analysis on immunohistochemical stained sections for Factor VIII-related antigen and analyzed for microvascular density.

Results:

Picrosirius red polarizing microscopy results revealed that there was a shift in the colour of collagen fibers from greenish yellow to orange red and red colour as the severity of the oral submucous fibrosis increased. The collagen fibers showed mixed orientation in early oral submucous fibrosis and parallel orientation in advanced oral submucous fibrosis. There was a significant decrease in microvascular density from early to advanced oral submucous fibrosis.

Conclusion:

The change in the colours and orientation of collagen fibers in early and advanced oral submucous fibrosis could be attributed to the fibre thickness, type of collagen, alignment and packing, cross-linking of the fibers and the section thickness. However, in advanced cases the vascularity is reduced which may predispose to epithelial atrophy and subsequent malignant changes.

Ultrastructural Changes of Collagen in Different Histopathological Grades of Oral Submucous Fibrosis

Background and Objectives:

Oral submucous fibrosis (OSMF) is a potentially malignant disorder and a crippling condition of oral mucosa. It is usually seen in adults with areca nut chewing habit, which is characterized by changes in the connective tissue fibers leading to stiffness of the mucosa and restricted mouth opening. Patients with severe cases have distinct difficulties in chewing, swallowing, and speaking. It predominantly occurs in Indians and other population of the Indian subcontinent with a prevalence of 0.2%–0.5%. The potentiality of malignant transformation associated with OSMF is much higher with a range of 4.5%–7.6%. This article is about the ultrastructural changes pertaining to collagen and with respect to the histopathological grades of OSMF.

Materials and Methods:

A total of 20 biopsy samples from clinically diagnosed OSMF subjects and 5 healthy controls were collected. After obtaining the biopsy, the specimens were divided into two halves, of which one was studied under light microscope and the other half was observed under transmission electron microscope.

Results:

Of the 20 subjects in the study group, most of the subjects were in the 20–29 years age group with an overall male predilection (19 subjects). Four subjects were in grade 1, nine were in grade 2, and seven were in grade 3. Collagen showed sparse to dense fibrosis and normal to thick collagen bundles, and some subjects showed encroachment of collagen into the blood vessels.

Conclusion:

This study showed definitive changes with respect to collagen in the OSMF samples compared to the controls. The changes were found to be increasing with the progression of the disease to the higher grades. The changes were pertaining to the collagen and were drawing toward an increased fibrosis of the connective tissue, which compresses the blood vessels. Hence, the state of hypoperfusion and subsequent epithelial atrophy can be considered in the progression of disease to the higher grades.

Alteration of Serum Lipid in Oral Sub Mucous Fibrosis in Central India

Oral sub mucous fibrosis is the most common precancerous lesion in India. Lipids are the major cell membrane components essential for various biological function including cell growth and division for the maintenance of cell integrity of normal and malignant tissue. Low levels of lipids serves as a marker and prognostic indicator in the early detection of oral precancerous and cancerous states. In spite of high prevalence and its potential to undergo malignant transformation, this condition has not widely been investigated with respect to serum lipid levels. In present study an attempt is made to analyze the complete serum profile, total cholesterol, triglycerides, high density lipoprotein. Low density lipoprotein, and very low density lipoprotein in oral precancerous lesion and control. Study was conducted in 30 clinically and histopathologically diagnosed cases of premalignant lesion and 30 age and sex match controls. The complete lipid profile including TC, TG, HDL, LDL, and VLDL was analyzed. Serum lipid levels were significantly lower in patients with oral lesion than in controls. From the finding it appears that the decreases in the lipid levels may be considered as useful marker in the early diagnosis of oral premalignant lesion.

Polarized microscope assisted study of collagen fibres in Oral Submucous Fibrosis and their clinicopathologic correlation: An in-vitro study

Background

The present study was aimed to evaluate and analyze orientation and birefringence pattern of collagen fibers histopathologically in different grades of OSMF using the special stain (Picrosirius red) under polarizing microscope and relate these factors with the severity of OSMF.

Materials and Method

45 confirmed cases of OSMF were taken from the archives. The selection of clinical cases was done according to classification by J.N Khanna and Andrade (1999). These cases were correlated histopathologically as per the criteria given by Pindborg J.J and Sirsat S.M (1966). The sections were stained with H & E and Picrosirius red stains and assessment was done accordingly. 10 cases of normal mucosa were taken as control.

Results

In clinical grade I, 60% of the cases showed histopathological grade II, while 53.4% cases in clinical grade II correlated with histopathological grade III and 33.4% of clinical grade III cases showed histopathological grade IV. Upon application of Fisher's exact test a significant P value <.01 was obtained suggesting no statistical significant correlation between these two parameters. However, the orientation pattern revealed a parallel orientation as OSMF advanced. Also as the severity of the disease increased, there was a gradual shift from green- greenish yellow colour of the fibres and a shift to orange red-red colour.

Conclusion

Upon correlation of clinical grades with histopathological grades, no statistically significant difference was found. Birefringence pattern of collagen revealed similar findings as other studies in case of clinical grades but histopathological grades showed a contrast finding.

Self-perceived oral symptoms and periodontal inflammatory conditions in habitual naswar dippers

Objectives:

To compare self-perceived oral symptoms and clinical (plaque index [PI], bleeding on probing [BOP], clinical attachment loss [CAL]) and radiographic (marginal bone loss [MBL]) periodontal parameters among naswar (NW) and non-naswar dippers (NNW).

Methods:

One hundred and forty-two individuals (72 patients consuming naswar and 70 controls) were included. All participants completed a baseline questionnaire that included information regarding demographic characteristics and self-perceived oral symptoms. Clinical periodontal parameters (PI, BOP, PD and CAL) were recorded. MBL was measured on digital panoramic radiographs.

Results:

Pain in teeth, pain on chewing, bleeding gums and burning sensation in the mouth was significantly worse among NW than NNW (p<0.01). Clinical periodontal parameters and MBL were significantly high in NW than NNW (p<0.001). There was statistically significant influence of daily use and mean duration of naswar consumption on the severity of PI, BOP, PD (4 to 6 and >6 mm) and MBL among NW group.

Conclusions:

Self-perceived oral symptoms and periodontal parameters were worse among naswar dippers. It is highly recommended that naswar dipping should be considered a potential threat that could have major effects on periodontal tissues.

Estimation of Salivary and Serum Lactate Dehydrogenase in Oral Submucous Fibrosis

AIM AND OBJECTIVES

The objective of the present study was to estimate the serum and salivary lactate dehydrogenase (LDH) levels in patients with oral submucous fibrosis (OSMF) and to study the association between serum and salivary LDH levels and mouth opening, frequency of habit, and duration of habit in patients with OSMF.

MATERIALS AND METHODS

Participants were divided into two groups: Group I - case group diagnosed with OSMF and Group II - the control group. Unstimulated whole saliva was collected from all the participants. The International Federation of Clinical Chemistry method was carried out with the help of LDH (P-L) kit (Crest Biosystems, Goa). Collection of blood sample was done under aseptic precautions and processed for LDH. The data were analyzed using SPSS software 2010 (version 19, IBM, Armonk, NY, USA). Descriptive statistics including mean, range, standard deviation, and percentage were used along with unpaired t-test and Pearson's correlation test.

RESULTS

All the participants were male and were in the age range of 18-60 years, with a mean age of 28.63 ± 10.39 years. The mean salivary LDH levels in patients with OSMF were 1057.30 ± 640.12 μg/dl and in the control group were 668.25 ± 498.45 μg/dl. The mean serum LDH level in patients with OSMF was 408.35 ± 158.35 μg/dl as compared to the control group was 313.05 ± 82.69 μg/dl. The Pearson's correlation coefficient between serum LDH and frequency of habit, duration of habit, and mouth opening was found to be 0.55, 0.53, and 0.69, respectively. The Pearson's correlation coefficient between salivary LDH and frequency of habit, duration of habit, and mouth opening was found to be 0.33, 0.04, and 0.13, respectively. The Pearson's correlation coefficient between salivary LDH and serum LDH was found to be -0.18.

CONCLUSIONS

There was a significant increase in the serum and salivary LDH in OSMF patients as compared to controls; the salivary LDH did not seem to correlate with frequency of the habit, duration of the habit, or mouth opening of OSMF patients. However, serum LDH was found to correlate directly with frequency of the habit and mouth opening in OSMF patients. Hence, based on the results of the present study, it can be hypothesized that serum LDH is a better biological marker than salivary LDH in the evaluation of OSMF.

Correlation of Clinical and Histopathological Grades in Oral Submucous Fibrosis Patients with Oxidative Stress Markers in Saliva

This study aimed to correlate the oxidative stress marker levels in saliva with the clinical stage based on mouth opening, fibrotic bands and histopathological grades of oral submucous fibrosis (OSF) patients. The study included patients clinically diagnosed with OSF (n = 63) and equal number of age and gender matched controls. Patients with OSF were defined by mouth opening stage, fibrotic bands and histopathological grades. Unstimulated saliva from both control and OSF patients were analysed for oxidative markers like lipid peroxides (LPO), non-enzymic antioxidants [reduced glutathione (GSH), vitamin A, vitamin E, vitamin C] and enzymatic antioxidants [glutathione peroxidase (GPx), superoxide dismutase (SOD)] and correlated with different stages and grades. Total salivary protein and LPO were significantly increased in OSF group with no significant change in the levels of GSH compared to controls. In OSF patients, a significant decrease in the levels of vitamins A, C and E was observed. The activities of salivary SOD and GPx were significantly decreased in OSF patients compared to controls. These changes significantly correlated with the increasing and differing grades of OSF that reflects increased oxidative stress with the progress of OSF.

Non-linear optical microscopy and histological analysis of collagen, elastin and lysyl oxidase expression in breast capsular contracture

Background

Capsular contracture is one of the most common complications in surgical interventions for aesthetic breast augmentation or post-mastectomy breast reconstruction involving the use of silicone prostheses. Although the precise cause of capsular contracture is yet unknown, the leading hypothesis is that it is caused by long-term unresolved foreign body reaction towards the silicone breast implant. To authors’ best knowledge, this is the first study that elucidates the presence of lysyl oxidase (LOX)—an enzyme that is involved in collagen and elastin crosslinking within fibrous capsules harvested from patients with severe capsular contracture. It was hypothesized that over-expression of LOX plays a role in the irreversible crosslinking of collagen and elastin which, in turn, stabilizes the fibrous proteins and contributes to the progression of capsular contracture.

Methods

Eight fibrous capsules were collected from patients undergoing capsulectomy procedure, biomechanical testing was performed for compressive Young’s moduli and evaluated for Type I and II collagen, elastin and LOX by means of non-linear optical microscopy and immunohistology techniques.

Results

Observations revealed the heterogeneity of tissue structure within and among the collected fibrous capsules. Regardless of the tissue structure, it has been shown that LOX expression was intensified at the implant-to-tissue interface.

Conclusion

Our results indicate the involvement of LOX in the initiation of fibrous capsule formation which ultimately contributes towards the progression of capsular contracture.

Electronic supplementary material

The online version of this article (10.1186/s40001-018-0322-0) contains supplementary material, which is available to authorized users.

New Gene Markers for Metabolic Processes and Homeostasis in Porcine Buccal Pouch Mucosa during Cells Long Term-Cultivation-A Primary Culture Approach

The oral mucosal tissue is a compound structure composed of morphologically and physiologically different cell types. The morphological modification involves genetically determined lifespan, which may be recognized as the balance between cell survival and apoptosis. Although the biochemical processes and pathways in oral mucosa, with special regards to drug transport, delivery, and metabolism, are well known, the cellular physiological homeostasis in this tissue requires further investigation. The porcine buccal pouch mucosal cells (BPMCs) collected from 20 pubertal crossbred Landrace gilts, were used in this study. Immediately after recovery, the oral mucosa was separated micro-surgically, and treated enzymatically. The dispersed cells were transferred into primary in vitro culture systems for a long-term cultivation of 30 days. After each step of in vitro culture (IVC), the cells were collected for isolation of total RNA at 24 h, 7, 15, and 30 days of IVC. While the expression was analyzed for days 7, 15, and 30, the 24th hour was used as a reference for outcome calibration. The gene expression profile was determined using Affymetrix microarray assays and necessary procedures. In results, we observed significant up-regulation of SCARB1, PTGS2, DUSP5, ITGB3, PLK2, CCL2, TGFB1, CCL8, RFC4, LYN, ETS1, REL, LIF, SPP1, and FGER1G genes, belonging to two ontological groups, namely "positive regulation of metabolic process", and "regulation of homeostatic process" at 7 day of IVC as compared to down-regulation at days 15 and 30. These findings suggest that the metabolic processes and homeostatic regulations are much more intense in porcine mucosal cells at day 7 of IVC. Moreover, the increased expression of marker genes, for both of these ontological groups, may suggest the existence of not only "morphological lifespan" during tissue keratinization, but also "physiological checkpoint" dedicated to metabolic processes in oral mucosa. This knowledge may be useful for preclinical experiments with drugs delivery and metabolism in both animals and humans.

Antifibrotic effect of Ocimum basilicum L. and linalool on arecoline-induced fibrosis in human buccal fibroblasts

Aim:

To explore Ocimum basilicum L. (sweet basil) and linalool for their antifibrotic activity in an arecoline-induced in vitro fibrotic model.

Methods:

Leaf extract of O. basilicum L. (LEOB) and linalool were used as experimental agents to test their antifibrogenic activity in vitro. Half-maximal inhibitory concentration (IC50) for arecoline, ethanolic LEOB, and linalool was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. To evaluate the antifibrotic effect of ethanolic LEOB and linalool on pretreatment, that is, both the testing agents were added to the human buccal fibroblasts (HBFs) prior to induction with arecoline, and reverse transcriptase polymerase chain reaction (RT-PCR) was carried out to study the response of transforming growth factor beta (TGFβ), collagen 1 subtype A2 (COL1A2), and collagen 3 subtype A1 (COL3A1). To appreciate the morphological alterations in HBFs on treatment with arecoline, ethanolic LEOB, and linalool, Masson’s trichrome staining was performed.

Results:

Arecoline enhanced fibrotic activity by upregulating TGFβ1, COL1A2, and COL3A1 levels, whereas ethanolic LEOB and linalool on pretreatment significantly downregulated the increased levels of TGFβ1, COL1A2, and COL3A1 in primary HBF cell cultures.

Conclusion and implication to clinic:

Both ethanolic LEOB and linalool exhibited significant antifibrotic activity in an in vitro model. Further studies in an in vitro model can help attain a foundation for an herbal formulation in gel form that can be prescribed to patients diagnosed with oral submucous fibrosis for topical application. It can also be used synergistically with Western medicine.

Hematinic deficiencies and anemia in gastric parietal cell antibody-positive and -negative oral submucous fibrosis patients

BACKGROUND/PURPOSE

Previous studies showed that approximately 13-15% of male oral submucous fibrosis (OSF) patients are serum gastric parietal cell antibody (GPCA)-positive. This study assessed whether serum GPCA or OSF itself was a significant factor that caused hematinic deficiencies and anemia statuses in GPCA-positive or GPCA-negative OSF patients (GPCA+/OSF and GPCA-/OSF patients).

MATERIALS AND METHODS

The frequencies of macrocytosis (mean corpuscular volume or MCV ≧ 100 fL) and blood hemoglobin (Hb), iron, vitamin B12 and folic acid deficiencies were determined and compared between any two of the four groups of 149 male OSF, 23 male GPCA+/OSF, and 126 male GPCA-/OSF patients and 149 age-matched male healthy control subjects.

RESULTS

All three groups of OSF patients (including 149 OSF, 23 GPCA+/OSF, and 126 GPCA-/OSF patients) had a significantly higher frequency of Hb, vitamin B12, or folic acid deficiency and of macrocytosis than 149 healthy control subjects (all P-values < 0.05). The 23 GPCA+/OSF patients did have a significantly lower mean serum vitamin B12 level and a significantly higher MCV or frequency of vitamin B12 deficiency than the 126 GPCA-/OSF patients. Two of the 23 GPCA+/OSF patients had pernicious anemia. Of the 126 GPCA-/OSF patients, 6 had macrocytic anemia, 2 had iron deficiency anemia, and 4 had thalassemia trait-induced anemia.

CONCLUSION

We conclude that OSF itself does play a significant role in causing hematinic deficiencies and anemia in OSF, GPCA+/OSF, and GPCA-/OSF patients. The serum GPCA is the major factor that causes vitamin B12 deficiency, macrocytosis, and pernicious anemia in GPCA+/OSF patients.

Serum-based diagnostic prediction of oral submucous fibrosis using FTIR spectrometry

Oral submucous fibrosis (OSF) is found to have the highest malignant potentiality among all other pre-cancerous lesions. However, its detection prior to tissue biopsy can be challenging in clinics. Moreover, biopsy examination is invasive and painful. Hence, there is an urgent need of new technology that facilitates accurate diagnostic prediction of OSF prior to biopsy. Here, we used FTIR spectroscopy coupled with chemometric techniques to distinguish the serum metabolic signatures of OSF patients (n=30) and healthy controls (n=30). Serum biochemical analyses have been performed to further support the FTIR findings. Absorbance intensities of 45 infrared wavenumbers differed significantly between OSF and normal serum FTIR spectra representing alterations in carbohydrates, proteins, lipids and nucleic acids. Nineteen prominent significant wavenumbers (P≤0.001) at 1020, 1025, 1035, 1039, 1045, 1078, 1055, 1100, 1117, 1122, 1151, 1169, 1243, 1313, 1398, 1453, 1544, 1650 and 1725cm^-1 provided excellent segregation of OSF spectra from normal using multivariate statistical techniques. These findings provided essential information on the metabolic features of blood serum of OSF patients and established that FTIR spectroscopy coupled with chemometric analysis can be potentially useful in the rapid and accurate preoperative screening/diagnosis of OSF.

Thioctic acid in oral submucous fibrosis (India's disease) - A better tomorrow

Oral submucous fibrosis (OSMF), because of its common occurrence in Indian population is known as India's disease. Regardless of diagnostic and therapeutic developments, oral potentially malignant disorders (PMD) and cancers are disseminating at a distressing rate. There is this prerequisite for unrelenting determination to find out apt treatment options so that malignant transformation may be prevented and more so the prevailing morbidity and mortality. Considering the frequency with which oral submucous fibrosis undergoes malignant transformation with free radicals playing a major part, the role of antioxidants in general and thioctic acid also known as alpha lipoic acid (ALA) in particular need to be studied in these individuals. Previous few studies indicated the use of alpha lipoic acid in oral submucous fibrosis patients leading to improvement in signs and symptoms. So, it led us to set forth and propose probable role of thioctic acid in improving symptoms in these patients. As oral submucous fibrosis poses as a threat with its various signs and symptoms and as a potentially malignant disorder as well as considering the role of free radicals in malignant transformation, we proposed the possible mechanisms behind the commonest signs and symptoms in oral submucous fibrosis and role of alpha lipoic acid in managing these signs and symptoms.

Evaluation of the diagnostic efficacy and spectrum of autofluorescence of benign, dysplastic and malignant lesions of the oral cavity using VELscope

OBJECTIVES

Conventional oral examination and biopsy are the only reliable methods for the early detection of oral cancer at present. Autofluorescence examination of oral tissues using the VELscope has been suggested as an adjunctive tool for cancer detection and diagnosis. The aim of our study was to evaluate the efficacy of the VELscope in recognizing dysplastic and/or neoplastic changes in oral mucosal lesions that were identified on conventional oral examination.

MATERIALS AND METHODS

Two hundred patients with oral mucosal lesions were subjected to conventional oral examination followed by VELscope examination and their autofluorescence characteristics were compared with the histopathological diagnosis. The sensitivity, specificity, positive and negative predictive values of the VELscope examination was calculated.

RESULTS

The VELscope examination showed sensitivity and specificity values of 76% (95% CI: 54.87-90.64%) and 66.29% (95% CI: 58.76-73.24%) respectively while the positive and negative predictive values were 24.36% (95% CI: 19.22-30.36%) and 95.08% (95% CI: 90.52-97.51%) respectively.

CONCLUSION

The VELscope examination alone cannot provide a definitive diagnosis as to the presence of dysplastic tissue change. In spite of having a reasonable sensitivity, the high number of false-positive results limits its efficiency as an adjunct. However, a high negative predictive value can serve to alleviate patient anxiety regarding suspicious mucosal lesions in a general practice setting.

Oral submucous fibrosis: Newer proposed classification with critical updates in pathogenesis and management strategies

Oral submucous fibrosis (OSMF) is an oral precancerous condition characterized by inflammation and progressive fibrosis of the submucosal tissues resulting in marked rigidity and trismus. OSMF still remains a dilemma to the clinicians due to elusive pathogenesis and less well-defined classification systems. Over the years, many classification systems have been documented in medical literature based on clinical, histopathological, or functional aspects. However, none of these classifications have achieved universal acceptance. Each classification has its own merits and demerits. An attempt is made to provide and update the knowledge of classification system of OSMF so that it can assist the clinicians, beneficial in researches and academics in categorizing this potentially malignant disease for early detection, prompt management, and reducing the mortality. Along with this, pathogenesis and management have also been discussed.

Translational approach utilizing COX-2, p53, and MDM2 expressions in malignant transformation of oral submucous fibrosis

About 20% of the world's population uses some form of betel nut, which suggests that the incidence of oral submucous fibrosis (OSF) is higher than current estimates. OSF has the potential to undergo malignant transformation; thus, there is a need to identify relevant markers to assess its aggressiveness. We evaluated changes in COX-2, p53, and MDM2 expressions in progressive OSF. Expressions of COX-2, p53, and MDM2 increased with OSF progression. There was a strong association between COX-2 overexpression and recurrence of oral squamous cell carcinoma (P < 0.001) and a positive relation between increased MDM2 expression and failure of radiotherapy (P = 0.007). These findings suggest that COX-2 is an important marker of disease progression and that MDM2 expression is useful for treatment planning.

Oral squamous cell carcinoma in the background of oral submucous fibrosis is a distinct clinicopathological entity with better prognosis

BACKGROUND

The aim of this study was to compare the clinicopathological features of oral squamous cell carcinoma in the background of oral submucous fibrosis (OSCC-OSMF) and oral squamous cell carcinoma (OSCC).

METHODS

A total of 217 cases of OSCC were retrieved from achieves for the analysis. OSCC-OSMF cases were segregated on the basis of history and clinicopathological parameters.

RESULTS

The study included 217 patients of which 112 had OSCC and 105 OSCC-OSMF. OSCC-OSMFs were younger compared with OSCC. Overall oral cancer was noted predominantly in males compared to females. The number of OSCC-OSMF was more in clinical TNM stage I and stage II as compared to OSCC, whereas the number of OSCC was more in stage III and stage IV compared to OSCC-OSMF. Histological presentation of well-differentiated squamous cell carcinoma was significantly more in OSCC-OSMF compared to OSCC, whereas moderately differentiated squamous cell carcinoma was significantly more in OSCC compared to OSCC-OSMF. Regional lymph node metastasis was significantly higher in OSCC compared to OSCC-OSMF. Three-year disease-free survival rate was significantly higher in OSCC-OSMF compared to OSCC.

CONCLUSION

The OSCC-OSMF was found to be a clinicopathologically distinct entity with a better grade of tumor differentiation, less incidence of nodal metastases, and early detection (early clinical TNM stage) compared to OSCC. All these factors probably contribute to a better prognosis and increased 3-year disease-free survival in OSCC-OSMF patients.

Low-power laser irradiation inhibits arecoline-induced fibrosis: an in vitro study

Oral submucous fibrosis (OSF) is a potentially malignant disorder that is characterized by a progressive fibrosis in the oral submucosa. Arecoline, an alkaloid compound of the areca nut, is reported to be a major aetiological factor in the development of OSF. Low-power laser irradiation (LPLI) has been reported to be beneficial in fibrosis prevention in different damaged organs. The aim of this study was to investigate the potential therapeutic effects of LPLI on arecoline-induced fibrosis. Arecoline-stimulated human gingival fibroblasts (HGFs) were treated with or without LPLI. The expression levels of the fibrotic marker genes alpha-smooth muscle actin (α-SMA) and connective tissue growth factor (CTGF/CCN2) were analysed by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) and western blots. In addition, the transcriptional activity of CCN2 was further determined by a reporter assay. The results indicated that arecoline increased the messenger RNA and protein expression of CCN2 and α-SMA in HGF. Interestingly, both LPLI and forskolin, an adenylyl cyclase activator, reduced the expression of arecoline-mediated fibrotic marker genes and inhibited the transcriptional activity of CCN2. Moreover, pretreatment with SQ22536, an adenylyl cyclase inhibitor, blocked LPLI's inhibition of the expression of arecoline-mediated fibrotic marker genes. Our data suggest that LPLI may inhibit the expression of arecoline-mediated fibrotic marker genes via the cAMP signalling pathway.

Estimation of hemoglobin, serum iron, total iron-binding capacity and serum ferritin levels in oral submucous fibrosis: A clinicopathological study

INTRODUCTION

Oral submucous fibrosis (OSMF) is also considered as an Asian version of sideropenic dysphagia, wherein chronic iron deficiency leads to mucosal susceptibility to irritants, such as chillies and areca nut products. Hemoglobin (Hb) levels, in particular, serum iron levels, are considered as biochemical indicators for nutritional assessment. Serum iron content can thus be a predictor for the progression of the condition, and there appears to be an association between serum iron content and oral carcinogenesis. Therefore, biochemical assessment of oral precancerous conditions may help in early diagnosis and prognosis. Hence, the present study was aimed to evaluate Hb, serum iron, total iron-binding capacity (TIBC) and serum ferritin in OSMF patients.

MATERIALS AND METHODS

Forty cases of OSMF were staged clinically and graded histopathologically to assess the levels of Hb, serum iron, TIBC and serum ferritin and compared with normal subjects. The results were compared using t-test, ANOVA, and Tukeys multiple post hoc procedures.

RESULTS

It was observed that the levels of Hb, serum iron and serum ferritin levels gradually reduced in OSMF patients compared with controls and as the clinical stage and histological grade of OSMF progressed with a statistically significant P < 0.05. It was observed that the levels of TIBC gradually increased in OSMF patients compared with controls and as the clinical stage and histological grade of OSMF progressed with a statistically significant P < 0.05.

CONCLUSION

The Hb, serum iron and serum ferritin levels in OSMF patients were reduced and TIBC increased as compared with controls and as the clinical stage and histological grade of OSMF advances indicating their role as a reliable biochemical indicator.

Omega 3: a novel treatment agent in oral submucous fibrosis: a pilot study

BACKGROUND

Oral submucous fibrosis (OSF) is a chronic debilitating disease and a premalignant condition of the oral cavity. It is well known for its impervious nature to medical therapy. Omega-3 polyunsaturated fatty acids have been reported to have anti-inflammatory properties. However, its role in OSF is still not known. This preliminary study assessed the efficacy of systemic omega 3 in this disease.

METHODS

A randomized single-blinded controlled trial was designed, and a total of 10 clinically confirmed adult patients with OSF were included in the study. Group A was given biweekly intralesional injections of dexamethasone 1.5 ml and hyaluronidase 1500 IU mixed with lignocaine for 6 weeks and a placebo for 3 months. Group B was also given similar intralesional injections but with 1 gm of omega 3 three times daily continuously for 3 months. Patients were followed every month for 3 months and then after 6 months.

RESULTS

Significant improvement was noted among all clinical parameters (interincisal distance, tongue protrusion, cheek flexibility, and visual analogue scale) in both the groups. Intergroup comparison showed significant reduction in burning sensation in group B; that is, P value was 0.005, while improvement in rest of the three clinical features was not statistically significant.

CONCLUSION

Omega 3 can be used as an adjunctive treatment option in patients with OSF to reduce subjective symptoms. More studies should be conducted with a larger sample size to study the effect of omega 3 in patients with OSF.

Expression of fibrosis-related molecules in the oral mucosa of six animal species: A reference for selecting animal models

Several animal models have been used in studies associated with oral submucous fibrosis (OSF); however, an appropriate model based on the histopathological characteristics of OSF is still needed. This study aimed to provide histological references for selecting a potential model. The expression intensities of collagen type I (Col I), type III (Col III), type IV (Col IV), fibronectin (FN), transforming growth factors β (TGF-β), and connective tissue growth factor (CCN2) in the oral mucosa of the human and six non-human animal species were measured by immunohistochemistry. There was little variation in the expression intensity of Col I while the expression of Col III, Col IV, and FN showed differences. The expression intensities of TGF-β in dog, rat, sheep, and pig oral mucosae, and those of CCN2 in dog, minipig, rat, and buffalo oral mucosae were equivalent to the expression intensities in human mucosa. The expression of fibrosis-related molecules in the dog oral mucosa optimally mimics the human condition, suggesting its suitability with regard to histopathology as an animal model for the study of OSF.

Assessment of serum copper, iron and immune complexes in potentially malignant disorders and oral cancer

Potentially malignant disorders (PMDs) of oral cavity and oral cancer remain a cause of serious concern despite intensive research and development. Diet and immunity have been identified to play a crucial role as modifying factors in these diseases. Our study intended to explore this relationship by estimating and comparing the serum levels of copper, iron and circulating immune complexes (CICs) in patients diagnosed with PMDs and oral cancer and normal healthy individuals. In this study, 40 histopathologically diagnosed cases of PMDs and oral cancer were included along with 30 healthy controls and 5 ml of venous blood was drawn using venipuncture. Serum estimation of copper, iron and CIC then followed using the colorimetric and spectrophotometric methods. The data obtained was subjected to statistical analysis using one way ANOVA and Pearson's Product-Moment Correlation Test. The mean serum copper level was measured as 138.98 ± 10.13µg/100ml in the PMD group and 141.99 ± 21.44 µg/100ml in the oral cancer as compared to 105.5 + 18.81µ/100ml in the controls. The mean serum CIC levels was highest in the oral cancer (9.65 ± 0.16OD470) followed by the PMD group (0.18 + 0.21 OD470) and least in the control group (0.048 ± 0.02OD470). Whereas, the serum levels of iron showed a significant decrease in the PMD group (110.9 ± 10.54 µg/100ml) and the oral cancer group (114.29 ± 25.83 µg/100ml) as compared with the control group (136.85 ± 14.48 µg/100ml). There was no positive correlation obtained between the three groups with respect to the chosen parameters indicating that the variables were independent of each other. It can be thus be ascertained that trace elements like copper and iron as well as humoral responses (CICs) have a close relationship with PMDs and oral cancers.

Dental Informatics tool "SOFPRO" for the study of oral submucous fibrosis

Background:

Dental informatics is an evolving branch widely used in dental education and practice. Numerous applications that support clinical care, education and research have been developed. However, very few such applications are developed and utilized in the epidemiological studies of oral submucous fibrosis (OSF) which is affecting a significant population of Asian countries.

Aims and Objectives:

To design and develop an user friendly software for the descriptive epidemiological study of OSF.

Materials and Methods:

With the help of a software engineer a computer program SOFPRO was designed and developed by using, Ms-Visual Basic 6.0 (VB), Ms-Access 2000, Crystal Report 7.0 and Ms-Paint in operating system XP. For the analysis purpose the available OSF data from the departmental precancer registry was fed into the SOFPRO.

Results:

Known data, not known and null data are successfully accepted in data entry and represented in data analysis of OSF. Smooth working of SOFPRO and its correct data flow was tested against real-time data of OSF.

Conclusion:

SOFPRO was found to be a user friendly automated tool for easy data collection, retrieval, management and analysis of OSF patients.

A Rare Case of Tamarind Seed Induced Oral Submucous Fibrosis in a 12-Year-Old Indian Boy

Oral Submucous Fibrosis (OSMF) is a chronic debilitating, potentially malignant disorder of the oral cavity. It is characterized by restricted mouth opening which results due to abnormal accumulation of collagen in the sub-epithelial layers leading to dense fibrous bands in the mouth. The pathogenesis of the disease is believed to be multifactorial. However, literature reports suggest a strong association of OSMF and arecanut chewing habit. The present paper presents a case of OSMF in a 12-year-old boy without arecanut chewing habit, but with a heavy practice of chewing tamarind seeds.

Genetic variants in microRNA-146a (C>G) and microRNA-1269b (G>C) are associated with the decreased risk of oral premalignant lesions, oral cancer, and pharyngeal cancer

OBJECTIVE

To investigate the relationships between two single-nucleotide polymorphisms at miR-146a C>G (rs2910164) and miR-1269b G>C (rs7210937) and the risk of developing oral premalignant lesions (OPLs), oral squamous cell carcinoma (OSCC), pharyngeal SCC (PSCC), and oral and pharyngeal SCC (OPSCC).

DESIGN

Genotyping of miR-146a C>G and miR-1269b G>C was performed in two case-control studies using the TaqMan assay. A total of 197 healthy control subjects, 241 OPLs patients, and 188 OPSCC patients who habitually chewed betel quid (BQ) were recruited into one case-control study. Additionally, 668 cancer-free control subjects and 658 OPSCC patients were recruited into the other case-control study.

RESULTS

The G/G genotype at miR-146a C>G was associated with the decreased risk of OSCC [adjusted odds ratio (AOR)=0.66, P=0.040], PSCC (AOR=0.42, P=0.013), and OPSCC (AOR=0.63, P=0.020). Additionally, the C allelic type and C/C genotype at miR-1269b G>C decreased the risk of BQ-related oral leukoplakia (C vs. G: AOR=0.68, P=0.012;C/C vs. G/G: AOR=0.43, P=0.009), BQ-related OPLs (C vs. G: AOR=0.69, P=0.008;C/C vs. G/G: AOR=0.44, P=0.005), and BQ-related OPSCC (C vs. G: AOR=0.65, P=0.003;C/C vs. G/G: AOR=0.47, P=0.011). In OPSCC patients, the G/G genotype of miR-146a was correlated with well-differentiated cells (P=0.041), and the G/C and C/C genotypes of miR-1269b were correlated with the absence of lymph node involvement (P=0.031), especially in OSCC patients (P=0.038 and P=0.007, respectively).

CONCLUSION

The genetic variants of miR-146a and miR-1269b are biomarkers against the development of OPLs and OPSCC.

Quantitative proteomic analysis for novel biomarkers of buccal squamous cell carcinoma arising in background of oral submucous fibrosis

Background

In South and Southeast Asian, the majority of buccal squamous cell carcinoma (BSCC) can arise from oral submucous fibrosis (OSF). BSCCs develop in OSF that are often not completely resected, causing local relapse. The aim of our study was to find candidate protein biomarkers to detect OSF and predict prognosis in BSCCs by quantitative proteomics approaches.

Methods

We compared normal oral mucosa (NBM) and paired biopsies of BSCC and OSF by quantitative proteomics using isobaric tags for relative and absolute quantification (iTRAQ) to discover proteins with differential expression. Gene Ontology and KEGG networks were analyzed. The prognostic value of biomarkers was evaluated in 94 BSCCs accompanied with OSF. Significant associations were assessed by Kaplan-Meier survival and Cox-proportional hazards analysis.

Results

In total 30 proteins were identified with significantly different expression (false discovery rate < 0.05) among three tissues. Two consistently upregulated proteins, ANXA4 and FLNA, were validated. The disease-free survival was negatively associated with the expression of ANXA4 (hazard ratio, 3.4; P = 0.000), FLNA (hazard ratio, 2.1; P = 0.000) and their combination (hazard ratio, 8.8; P = 0.002) in BSCCs.

Conclusion

The present study indicates that iTRAQ quantitative proteomics analysis for tissues of BSCC and OSF is a reliable strategy. A significantly up-regulated ANXA4 and FLNA could be not only candidate biomarkers for BSCC prognosis but also potential targets for its therapy.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2650-1) contains supplementary material, which is available to authorized users.

Nutritional Aspects of Essential Trace Elements in Oral Health and Disease: An Extensive Review

Human body requires certain essential elements in small quantities and their absence or excess may result in severe malfunctioning of the body and even death in extreme cases because these essential trace elements directly influence the metabolic and physiologic processes of the organism. Rapid urbanization and economic development have resulted in drastic changes in diets with developing preference towards refined diet and nutritionally deprived junk food. Poor nutrition can lead to reduced immunity, augmented vulnerability to various oral and systemic diseases, impaired physical and mental growth, and reduced efficiency. Diet and nutrition affect oral health in a variety of ways with influence on craniofacial development and growth and maintenance of dental and oral soft tissues. Oral potentially malignant disorders (OPMD) are treated with antioxidants containing essential trace elements like selenium but even increased dietary intake of trace elements like copper could lead to oral submucous fibrosis. The deficiency or excess of other trace elements like iodine, iron, zinc, and so forth has a profound effect on the body and such conditions are often diagnosed through their early oral manifestations. This review appraises the biological functions of significant trace elements and their role in preservation of oral health and progression of various oral diseases.

Aberrant DKK3 expression in the oral leukoplakia and oral submucous fibrosis: a comparative immunohistochemical study

We aimed to assess and compare the expression of Dickkopf homolog 3 (DKK3), a possible tumor suppressor gene (TSG), in oral leukoplakia (OLK) and oral submucous fibrosis (OSF) using immunohistochemistry. Seventy-five cases of normal oral mucosa (NOM), OLK, OSF, and squamous cell carcinoma (OSCC) were studied. DKK3 was expressed in all cases of NOM, OLK and OSCC. There was steady increases in the percentage of the positive cells progressing toward OSCC. The expression was localized in the cytoplasm and cell membrane of cell affected by OLK with mild dysplasia and OLK with severe dysplasia. No significant association was observed between DKK3 expression and dysplastic status of OLK. Loss of DKK3 expression was observed in 15 of 30 cases in the OSF group, which was significantly associated with histological grade of OSF (P<0.0001). The percentage of positive cells gradually declined with the increasing severity of epithelial atrophy. A significant difference (P<0.01) was observed when comparing DKK3 expression among different groups of OLK and OSF cases. DKK3 may have diverse expressions in oral premalignant lesions. Loss of DKK3 expression in dysplastic/advanced stage of OSF may imply a high risk of progression to oral cancer.