Predictive value of salivary microRNA-320a, vascular endothelial growth factor receptor 2, CRP and IL-6 in Oral lichen planus progression

Sample-to-answer salivary miRNA testing: New frontiers in point-of-care diagnostic technologies

MicroRNA (miRNA), crucial non-coding RNAs, have emerged as key biomarkers in molecular diagnostics, prognosis, and personalized medicine due to their significant role in gene expression regulation. Salivary miRNA, in particular, stands out for its non-invasive collection method and ease of accessibility, offering promising avenues for the development of point-of-care diagnostics for a spectrum of diseases, including cancer, neurodegenerative disorders, and infectious diseases. Such development promises rapid and precise diagnosis, enabling timely treatment. Despite significant advancements in salivary miRNA-based testing, challenges persist in the quantification, multiplexing, sensitivity, and specificity, particularly for miRNA at low concentrations in complex biological mixtures. This work delves into these challenges, focusing on the development and application of salivary miRNA tests for point-of-care use. We explore the biogenesis of salivary miRNA and analyze their quantitative expression and their disease relevance in cancer, infection, and neurodegenerative disorders. We also examined recent progress in miRNA extraction, amplification, and multiplexed detection methods. This study offers a comprehensive view of the development of salivary miRNA-based point-of-care testing (POCT). Its successful advancement could revolutionize the early detection, monitoring, and management of various conditions, enhancing healthcare outcomes. This article is categorized under: Diagnostic Tools > Biosensing Diagnostic Tools > Diagnostic Nanodevices.

An exotic pathogenetic mechanism of angiogenesis in oral lichen planus-A systematic review

OBJECTIVE

Angiogenesis plays a vital role at the molecular level in various inflammatory lesions, that lead to their chronicity. Oral lichen planus is an immune-mediated chronic inflammatory disorder. The angiogenetic role and exact mechanisms in oral lichen planus are still unclear due to a dearth of studies. Its clinical significance with angiogenesis also requires further elucidation necessitating a thorough review of the studies that have been conducted so far. The present review was designed to identify the dependence of oral lichen planus progression on angiogenesis which could aid in devising metronomic treatments required to halt the progression of this disease.

MATERIALS AND METHODS

A thorough search was made using MEDLINE by PubMed, Scopus, Google scholar, Cochrane library, and EMBASE databases. Original research articles, that immunohistochemically evaluated angiogenesis in oral lichen planus were included for review. Risk of bias was analysed for each study using Modified Newcastle-Ottawa scale and Review Manager 5.4 was used to output its result.

RESULTS

Twenty-nine published articles were included for data synthesis. The most commonly employed antibody was CD34, however, upregulated VEGF expression was the principal while ICAM-1, VCAM-1, and PECAM-1 were critical angiogenic factors to mediate angiogenesis in oral lichen planus.

CONCLUSION

The current evidence supports that angiogenesis, a fundamental pathogenetic mechanism of oral lichen planus, leads to its persistence and chronicity. However, studies with a larger sample size, standard evaluation criteria, different subtypes, and adequate follow-up are warranted.

Association between Salivary Cortisol and α-Amylase with the Psychological Profile of Patients with Oral Lichen Planus and Burning Mouth Syndrome: A Case-Control Study

The aim of our study was to assess the relationship between the concentration/activity of salivary stress biomarkers (cortisol, α-amylase) and the psychological profile of patients with oral lichen planus (OLP) and primary burning mouth syndrome (BMS). A total of 160 subjects participated in this case-control study: 60 patients with OLP; 60 patients with primary BMS; and 40 control subjects. Unstimulated whole saliva (UWS) was collected between 9 and 10 a.m. Salivary biomarkers were analyzed by enzyme-linked immunosorbent assays (ELISAs). Psychological assessment was evaluated with the Depression, Anxiety, and Stress Scale (DASS-21). The patients with primary BMS had higher salivary cortisol concentrations and α-amylase activity (0.52 vs. 0.44 µg/dL; 160,531 vs. 145,804 U/L; one-way analysis of variance (ANOVA) with post hoc Scheffe test) compared with patients with OLP. The patients with primary BMS had statistically significant higher scores for depression, anxiety, and stress compared with patients with OLP and control subjects (p < 0.001, Kruskal-Wallis test). There was a strong positive correlation between anxiety and depression, stress and depression, and stress and anxiety in patients with OLP and BMS (p < 0.001 and p < 0.001, respectively; Spearman's correlation). There was a good positive correlation between symptom intensity (pain/burning) and psychological profile (depression, anxiety, stress) in patients with primary BMS (r = 0.373, p = 0.003; r = 0.515, p < 0.001; r = 0.365, p = 0.004, respectively; Spearman's correlation). This case-control study is the first to compare the psychoendocrinological profile of patients with two different oral diseases. The patients with BMS showed a higher concentration/activity of salivary stress biomarkers (cortisol, α-amylase) and a stronger association with mental disorders compared with patients with OLP. However, an interdisciplinary psychoneuroimmunological approach is equally important in both patient groups (OLP and BMS), regardless of whether mental disorders are the cause or the consequence.

The impact of neutrophil extracellular traps in coronavirus disease - 2019 pathophysiology

Coronavirus disease 2019 (COVID-19), which is caused by novel coronavirus-2019 (nCoV-2019), is a highly contagious disease with high mortality and morbidity risk. Infected people may suffer from respiratory infections, which may be more progressive in patients with a defective immune system and underlying medical problems. In this regard, the cells involved in the innate immune system, play a decisive role in disease progression and complication development. Pathogen entrapment is the critical role of neutrophil extracellular traps (NETosis). This process involves the widespread release of fibrous structures by the stimulant-activated neutrophils. These fibrous structures are composed of cytosolic proteins and granular contents brought together by a network of released chromatins. This network can inhibit the spread of pathogens by their entrapment. Moreover, NETosis damage the host by producing toxic agents and triggering thrombosis. Therefore, this phenomenon may act as a double-edged sword. Regarding the rapid expansion of COVID-19, it is crucial to examine the involvement of NETosis in infected patients. This study aims to discuss NETosis participation to show its probable association with increased risk of thrombogenicity and help develop new therapeutic approaches in the battle against this viral disease.

Saliva - a new opportunity for fluid biopsy

Saliva is a complex biological fluid with a variety of biomolecules, such as DNA, RNA, proteins, metabolites and microbiota, which can be used for the screening and diagnosis of many diseases. In addition, saliva has the characteristics of simple collection, non-invasive and convenient storage, which gives it the potential to replace blood as a new main body of fluid biopsy, and it is an excellent biological diagnostic fluid. This review integrates recent studies and summarizes the research contents of salivaomics and the research progress of saliva in early diagnosis of oral and systemic diseases. This review aims to explore the value and prospect of saliva diagnosis in clinical application.

Efficacy and safety of a bioadhesive gel containing propolis extract, nanovitamin C and nanovitamin E on desquamative gingivitis: a double-blind, randomized, clinical trial

OBJECTIVES

To evaluate the efficacy of a gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to professional plaque removal on desquamative gingivitis (DG).

MATERIALS AND METHODS

A randomized clinical trial was conducted on patients suffering DG due to mucocutaneous diseases. Patients received professional supragingival prophylaxis with oral hygiene instructions and were randomly assigned to use test or control gels as toothpaste and to apply it on DG lesions 3 times/day for 4 weeks. DG clinical score (DGCS), clinical periodontal variables, and visual analog scale (VAS) for pain and oral health impact profile (OHIP-14) were collected at baseline, 2 and 4 weeks.

RESULTS

Twenty-two patients were randomly assigned to test (n = 11) or control group (n = 11). Eighteen had diagnosis of oral lichen planus and four of mucous membrane pemphigoid. DGCS statistically decreased in both groups after treatment with no significant differences between groups. Clinical periodontal outcomes decreased in both groups, but no significant differences were observed. Periodontal variables statistically improved only in test group after treatment. VAS and OHIP-14 scores decreased in test and control groups without significant differences. However, only one test group showed a statistically significant decrease in VAS and OHIP-14 scores after treatment. No adverse effects were reported.

CONCLUSIONS

Test gel may alleviate DG and improve quality of life without side effects.

CLINICAL RELEVANCE

A gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to mechanical debridement may improve both clinical and patient related outcomes in DG patients without side effects.

CLINICAL TRIAL REGISTRATION

The study protocol was registered at clinicaltrials.gov with the following number: NCT05124366 on October 16, 2021.

Association of salivary miRNAs with onset and progression of oral potentially malignant disorders: Searching for noninvasive biomarkers

Background/purpose

There is an urgent need for noninvasive biomarkers to diagnose oral potentially malignant disorders (OPMD). A wide range of over 20 miRNAs in saliva of OPMD patients have been investigated in different studies. Yet, which of the ones provide a better power of discrimination for the diagnosis of OPMD onset and progression are uncertain.

Materials and methods

A total of 17 eligible studies including 426 cases of OPMD and 486 control subjects (352 normal mucosa and 134 oral squamous cell carcinoma) were summarized.

Results

The bubble chart analysis showed that the most power salivary miRNA associated with OPMD onset was miR-21, followed by miR-31 and miR-142; the better power miRNAs associated with recurrence and malignant progression of OPMD were miR-31, miR-21, and miR-184.

Conclusion

Salivary miRNAs, especially miR-21 and miR-31, were associated with onset and progression of OPMD, and could then serve as noninvasive biomarkers for screening OPMD and detecting malignant changes.

The expression of salivary microRNAs in oral lichen planus: Searching for a prognostic biomarker

Oral lichen planus (OLP) is a premalignant disease with unknown etiology. It has been demonstrated that inflammation and immune activation play a central role in the pathogenesis of OLP. Various cellular and molecular mechanisms are involved in the pathogenesis of OLP. Studies have shown that 2-7% of OLP patients develop oral squamous cell carcinoma (OSCC). As a result, determining the prognosis of the disease will be promising in preventing oral carcinoma. MicroRNAs are involved in the regulation of cytokine expression and cytokines have a central role in the pathogenesis of OLP. As a result, their evaluation in body fluids may be helpful in assessing the disease's status and progression, and facilitating the treatment process. In this regard, much attention has been paid to the saliva of OLP patients as the sampling is cost-effective and non-invasive. Here, we discuss the potential of miRNAs in predicting the disease severity and progression.

Probiotics as Potential Biological Immunomodulators in the Management of Oral Lichen Planus: What's New?

Oral lichen planus (OLP) is a T cell-mediated chronic inflammatory disorder with multifactorial aetiology and malignant transformation potential. Despite the treatments so far identified, new tailored and safe specific measures are needed. Recently, human microbiota imbalance has been linked to several immune-mediated diseases, opening new therapeutic perspectives for probiotics; besides their ability to directly interact with the host microbiota, they also display a strain-specific immune-modulatory effect. Thus, this non-systematic review aims to elucidate the molecular pathways underlying probiotic activity, mainly those of Lactobacilli and Bifidobacteria and their metabolites in OLP pathogenesis and malignant transformation, focusing on the most recent in vitro and in vivo research evidence. Findings related to their activity in other immune-mediated diseases are here included, suggesting a probiotic translational use in OLP. Probiotics show immune-modulatory and microbiota-balancing activities; they protect the host from pathogens, hamper an excessive effector T cell response, reduce nuclear factor-kappa B (NF-kB) signalling and basal keratinocytes abnormal apoptosis, shifting the mucosal response towards the production of anti-inflammatory cytokines, thus preventing uncontrolled damage. Therefore, probiotics could be a highly encouraging prevention and immunotherapeutic approach for a safer and more sustainable OLP management.

Recognizing the salivary panomics for the clinical application in oral potentially malignant disorders

Oral cancer arises as a result of multistep carcinogenic progress from precursor lesion to oral squamous cell carcinoma through collective mutational process occur in the stem cells of mucosal epithelium. The detection of such oral potentially malignant disorders (OPMDs)/cancer in subclinical level will greatly improve the prognosis of a patient. The highly specific and sensitive salivary biomarkers have functioned in detection, prediction, surveillance and therapeutic monitoring of the diseases of interest. The aim of the review is to appraise various salivary biomarkers for the clinical utility in OPMDs. An electronic web-supported search was performed via PubMed, ScienceDirect and Google Scholar search engine since the year 2015–2019. A total of 28 research articles were selected for the review after screening and assessment. The various genomic, transcriptomic, proteomic, metabolomic and miscellaneous markers were analyzed and their characteristics and clinical application in OPMD patients were discussed. miR-21, miR-31, miR-84, H3F3A mRNA + IL-8P, matrix metalloproteinase-9, chemerin, tumor necrosis factor-alpha, cytokeratin-10, ornithine + O-hydroxybenzoate + R5F, 8-hydroxy-2-deoxyguanosine, malondialdehyde, Vitamin E and Vitamin C are identified as potential markers for OPMD patients. Scientifically validated, reliable and economical clinical biomarkers in OPMDs would serve as evidence-based treatment from patient point of view. Further longitudinal studies are needed to verify the accuracy and validate the applicability of these diagnostic/prognostic markers. Saliva has been reported as a valuable noninvasive valuable tool in biomarker identification. Recent advancements in salivary biomarker identification techniques lead to various potential biomarkers with precise outcome. The utilization of these biomarkers for the clinical application in OPMDs depends on the feasibility and personal choice of the clinician.

The role of differentially expressed salivary microRNA in oral squamous cell carcinoma. A systematic review

OBJECTIVE

This study aims to systematically review the role of differentially expressed microRNA (miRNA) in saliva as potential biomarkers in oral cancer patients.

DESIGN

PubMed, Scopus and EBSCO online data bases were used as well as manual searching to extract studies from January 2008 up to October 2020.

RESULTS

A total of 14 studies that met the eligibility criteria were included. All selected studies were of case-control type. A total of 25 differentially expressed miRNAs were identified. Thirteen of these miRNAs (Let-7a, miR 27, miR 34, miR 92, miR 124, miR 125a, miR 136, miR139 miR 145, miR 146a, miR 200a, miR 205 and miR 375) were downregulated and other twelve (miR 9, miR 21, miR 31, miR 122, miR 134, miR 184, miR 191, miR 196a, miR 196b, miR 412, miR 512 and miR 8392) were upregulated. Four miRNAs were evaluated in more than one study (miR21, miR31, miR125 and miR 200).

CONCLUSION

According to these results, salivary miRNA can aid in diagnosis and prognosis of oral squamous cell carcinoma (OSCC). However, controlled clinical trials with a large sample size are required to validate the differentially expressed miRNAs of the present review.

Salivary Lactate Dehydrogenase, C-Reactive Protein, and Cancer Antigen 125 Levels in Patients with Oral Lichen Planus and Oral Squamous Cell Carcinoma

Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity and oral lichen planus (OLP) is considered a premalignant disease. Objectives: This study aims at comparing the salivary levels of lactate dehydrogenase (LDH), C-reactive protein (CRP), and cancer antigen 125 (CA125) among cases with OSCC, OLP, and healthy persons. Methods: In this case-control study, salivary markers were evaluated in 55 cases (15 patients with OSCC, 20 patients with OLP, and 20 healthy persons); non-stimulated saliva samples were collected from the patients and saliva markers were measured by the enzyme-linked immunosorbent assay (ELISA) method. The data were analyzed, using SPSS 21 software and ANOVA test and P < 0.05 was regarded as significant. Results: Salivary LDH and CA125 levels were significantly higher in OSCC and OLP patients compared to the control group (P < 0.05). Salivary CRP levels were significantly higher in OSCC patients compared to OLP patients (P < 0.05). Besides, salivary CRP levels were higher in OLP subjects than in the control group, but the difference was not significant (P = 0.56). Conclusions: The identification of the salivary LDH, CA125, and CRP may provide a suitable non-invasive predictive tool for malignant changes. However, its use in clinical practice needs further research.

Salivary Micro-RNA and Oral Squamous Cell Carcinoma: A Systematic Review

Oral squamous cell carcinoma (OSCC) is a widespread malignancy with high mortality. In particular, a delay in its diagnosis dramatically decreases the survival rate. The aim of this systematic review was to investigate and summarize clinical results in the literature, regarding the potential use of salivary microRNAs (miRNAs) as diagnostic and prognostic biomarkers for OSCC patients. Twelve papers were selected, including both case-control and cohort studies, and all of them detected significantly dysregulated miRNAs in OSCC patients compared to healthy controls. Based on our results, salivary miRNAs might provide a non-invasive and cost-effective method in the diagnosis of OSCC, and also to monitor more easily its evolution and therapeutic response and therefore aid in the establishment of specific therapeutic strategies.

Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies

Saliva is a highly versatile biological fluid that is easy to gather in a non-invasive manner—and the results of its analysis complement clinical and histopathological findings in the diagnosis of multiple diseases. The objective of this review was to offer an update on the contribution of salivary biomarkers to the diagnosis and prognosis of diseases of the oral cavity, including oral lichen planus, periodontitis, Sjögren’s syndrome, oral leukoplakia, peri-implantitis, and medication-related osteonecrosis of the jaw. Salivary biomarkers such as interleukins, growth factors, enzymes, and other biomolecules have proven useful in the diagnosis and follow-up of these diseases, facilitating the early evaluation of malignization risk and the monitoring of disease progression and response to treatment. However, further studies are required to identify new biomarkers and verify their reported role in the diagnosis and/or prognosis of oral diseases.

Inflammatory Markers and Incidence of other Autoimmune Diseases in Patients with Oral Lichen Planus

Introduction

Oral lichen planus (OLP) is a chronic immune, inflammatory disease of the oral cavity of a still unknown etiology.

Materials and methods

The study involved 63 subjects diagnosed with oral lichen planus and 63 subjects without pathologic changes in the oral mucosa who were classified as controls. All subjects were given a detailed medical history at first screening. The medical history of the presence of other autoimmune disease in all subjects was supported by medical records. A sample of venous blood was taken from each subject in order to determine sedimentation rate (SE) and leukocyte count (L) using standard laboratory procedures, and serum C-reactive protein (CRP) concentration values ​​were determined as well.

Statistical analysis

The methods of descriptive statistics, χ2-test, the Fisher's exact test, and the Student's t-test were used in the statistical processing of the results. The results were interpreted at a significance level of P <0.05.

Results

For all three measured inflammatory markers, there were no statistically significant differences in the number of subjects with elevated values ​​between the test and control groups (P = 0.364 for SE; P = 1.000 for CRP and P = 0.219 for L). The prevalence of other autoimmune disease in the OLP group was higher than in the control group, with statistical significance, and the most common was cutaneous lichen in nine subjects (14.29%) with OLP and celiac disease seven subjects (11.11%).

Conclusions

The results showed that there was no significant difference in the average values of the investigated inflammatory markers in blood (SE, CRP and L) between patients with OLP and control subjects, while a significantly higher incidence of other autoimmune diseases in patients with OLP was demonstrated.

Histopathological features of oral lichen planus and its response to corticosteroid therapy: A retrospective study

Oral lichen planus (OLP) exhibits variations in severity and response to corticosteroid therapy. This study aims to assess the histopathological features of OLP at the time of diagnosis and their relationship in response to corticosteroid therapy.In this retrospective study, OLP patients were selected if a histopathological report was available. Data were collected regarding patients' demographics and medical history. Clinical and histological data were also obtained. The outcomes were histopathological findings, clinical form of OLP, number of exacerbations per year, and the response to corticosteroid therapy.In this study, 100 OLP patients were enrolled. Basal layer hydropic degeneration and band-like subepithelial lymphocytes infiltrate were observed in all patients. Plasma cells, identified in 62% of OLP patients, were significantly associated with fewer disease exacerbations and better response to corticosteroid treatment.Identifying histopathological features that may affect the clinical course would be clinically helpful in tailoring patient management.

Evaluation of Serum and Salivary Interleukin-6 and Interleukin-8 Levels in Oral Squamous Cell Carcinoma Patients: Systematic Review and Meta-Analysis

This meta-analysis aimed to assess the salivary and serum concentrations of IL-6 and IL-8 in oral squamous cell carcinoma (OSCC) patients compared to the controls. Four electronic databases (Scopus, PubMed, Cochrane Library, and Web of Science) were searched up to January 2019. The study quality was checked according to the Newcastle-Ottawa Scale. The mean difference (MD) plus 95% confidence interval (95%CI) were calculated using RevMan 5.3 software. The publication bias and sensitivity analysis were done using CMA 2.0 software. Out of 309 studies retrieved from the 4 databases, 26 studies were analyzed in the present meta-analysis. In this meta-analysis, the pooled MD in the OSCC patients compared to the controls was 19.06 pg/mL (95%CI: 14.78-23.33) for the serum IL-6 level, 199.14 pg/mL (95%CI: 47.39-350.89) for the serum IL-8 level, 122 pg/mL (95%CI: 64-179) for the salivary IL-6 level, and 958 pg/dL (95%CI: 718-1197) for the salivary IL-8 level. All values in this meta-analysis were statistically significant. In conclusion, according to the meta-analysis results, the serum and salivary IL-6 and IL-8 levels in OSCC patients were significantly elevated compared to the controls, and both cytokines can be useful as potential biomarkers in early OSCC diagnosis.

Oral White Lesions: An Updated Clinical Diagnostic Decision Tree

Diagnosis of oral white lesions might be quite challenging. This review article aimed to introduce a decision tree for oral white lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “mouth disease”, “oral keratosis”, “oral leukokeratosis”, and “oral leukoplakia”. Related English-language articles published since 2000 to 2017, including reviews, meta-analyses, and original papers (randomized or nonrandomized clinical trials; prospective or retrospective cohort studies), case reports, and case series about oral diseases were appraised. Upon compilation of data, oral white lesions were categorized into two major groups according to their nature of development: Congenital or acquired lesions and four subgroups: Lesions which can be scraped off or not and lesions with the special pattern or not. In total, more than 20 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.

Diagnostic and prognostic relevance of salivary microRNA-21, -125a, -31 and -200a levels in patients with oral lichen planus - a short report

BACKGROUND

Oral lichen planus (OLP), a relatively common chronic inflammatory disease of the oral mucosa, is considered to be a premalignant disorder of the oral cavity. Previously, several biomarkers have been tested for their diagnostic potential. Here, we aimed to investigate the diagnostic potential of four miRNAs, miR-21, -125a, -31 and -200a, known to be involved in oral squamous cell carcinoma (OSCC) development, in the saliva of OLP patients as also their putative relation to OSCC development in these patients.

MATERIALS AND METHODS

Saliva samples from 30 patients with OLP were collected, 15 of whom were diagnosed with dysplasia upon histopathologic examination. In addition, 15 saliva samples from patients with OSCC and 15 saliva samples from healthy donors were collected. After RNA extraction, the respective miRNA levels were assessed by quantitative RT-PCR.

RESULTS

We found that the miR-21 levels were significantly increased in saliva samples derived from patients with OLP, dysplastic OLP and OSCC, compared to those from healthy controls (p = 0.012, p = 0.0017 and p < 0.0001, respectively). Conversely, significant decreases in miR-125a levels were found in the OLP, dysplastic OLP and OSCC samples, compared to those from healthy controls (p < 0.0014, p < 0.0001 and p < 0.0001, respectively). In addition, significant increases in miR-31 levels were found in samples derived from dysplastic OLP and OSCC patients, but not in those from nondysplastic OLP patients, compared to those in healthy controls (p = 0.01 and p = 0.004, respectively). Finally, we found that the miR-200a levels were significantly decreased only in samples derived from OSCC patients (p < 0.0001).

CONCLUSIONS

From our data we conclude that increased miR-21 levels in conjunction with decreased miR-125a levels in saliva of OLP patients may be indicative for a poor prognosis. Conversely, we conclude that lack of significant alterations in miR-31 and miR-200a levels in saliva of OLP patients may be indicative for absence of malignant transformation.