Immune activation and chronic inflammation as the cause of malignancy in oral lichen planus: is there any evidence ?

Prognosis of oral epithelial dysplasia in individuals with and without oral lichen planus

OBJECTIVES

To investigate the role of oral lichen planus (OLP) on the long-term prognosis of oral epithelial dysplasia (OED).

METHODS

Retrospective single-centre cohort study using the 2007-2019 database of the Head and Neck Cancer and Oral Medicine units of University College London Hospital. The exposure of interest was the presence of OLP, and the prognostic outcomes included the development of new primary episodes of OED, progression to malignancy and mortality. Cox proportional hazard and Poisson regression models were performed.

RESULTS

A total of 299 patients, of whom 144 had OED arising on the background of OLP (OLP/OED) and 155 had OED without underlying OLP (non-OLP/OED), were included. A pre-existing diagnosis of OLP was significantly associated with a twofold increased risk of subsequent primary OED events (HR = 2.02, p = 0.04), which also developed faster (1.46 vs. 2.96 years, p = 0.04) and with more involvement of non-cancer-prone sites (p = 0.001) than in the non-OLP/OED group. There was no difference between groups in the progression to malignancy or mortality.

CONCLUSIONS

Oral lichen planus/OED patients are at higher risk of multiple episodes of primary OED, which can develop faster and at non-cancer-prone sites as compared to non-OLP/OED individuals. Further research is needed to clarify the effects of OLP upon progression to OSCC and mortality.

Narrow-band imaging features of oral lichenoid conditions: A multicentre retrospective study

OBJECTIVE

Narrow-band imaging (NBI), which highlights epithelial intrapapillary capillary loops (IPCLs) classified into five patterns (0 toIV) with increasing correlation to malignancy, has demonstrated effectiveness for detection of oral squamous cell carcinoma (OSCC). Lack of standardised procedures limits its use for routine inspection of oral lichenoid lesions including oral lichen planus (OLP), oral lichenoid lesion (OLL) and oral lichenoid reaction (OLR). The aim of this study was to analyse IPCL patterns of such lesions, assessing correlations with histopathological outcomes.

MATERIALS AND METHODS

A multicentre, retrospective study was performed on 84 patients who underwent NBI and subsequent biopsy for suspected OLP/OLL/OLR. Patients were examined with Evis Exera III NBI system. Recorded NBI video endoscopies were evaluated to assess IPCL patterns and correlated with histopathological outcomes.

RESULTS

No significant differences were detected among OLP/OLL/OLR on NBI inspection. All lichenoid lesions were significantly related to low-grade (0-II) IPCL patterns, clearly distinguishable from OSCC, showing pattern IV (p < 0.05).

CONCLUSIONS

NBI cannot discern among OLP/OLL/OLR lesions. Interpretation should be modulated when assessing lichenoid lesions. NBI has potential to discern malignant transformation occurring in lichenoid lesions undergoing long-term follow-up, as IPCL pattern IV may be used as a clinical marker of malignancy arising in chronic inflammatory lesions.

Updates on immunological mechanistic insights and targeting of the oral lichen planus microenvironment

Oral lichen planus (OLP) is a chronic immune inflammatory disease that is an oral potentially malignant disorder (OPMD), occurs in the oral mucosa and affects approximately 0.5% to 4% of the general population. There are usually five types of OLP: reticular/papular, plaque-like, atrophic/erythematous, erosive/ulcerative, and bullous. Furthermore, the chance of causing oral squamous cell carcinoma (OSCC) is 1.4%. Although the etiology of OLP is still unknown, accumulating evidence supports that immune dysregulation may play a vital role in the pathogenesis of OLP, especially the massive production of various inflammatory cells and inflammatory mediators. In this review, we focus on the relationship between OLP and its immune microenvironment. We summarize current developments in the immunology of OLP, summarizing functional cell types and crucial cytokines in the OLP immune microenvironment and the underlying mechanisms of key signaling pathways in the OLP immune microenvironment. We highlight the application potential of targeted immune microenvironment therapy for OLP.

Differential proteomic expression in indolent versus transforming oral lichen planus

Oral lichen planus (OLP) confers an approximately 1% risk of transformation to oral squamous cell carcinoma (OSCC). Early identification of high-risk OLP would be very helpful for optimal patient management. We aimed to discover specific tissue-based protein biomarkers in patients with OLP who developed OSCC compared to those who did not. We used laser capture microdissection- and nanoLC-tandem mass spectrometry to assess protein expression in fixed lesional mucosal specimens in patients with indolent OLP (no OSCC after at least 5-year follow-up, n = 6), transforming OLP (non-dysplastic epithelium with lichenoid inflammation marginal to OSCC, n = 6) or normal oral mucosa (NOM, n = 5). Transforming OLP protein profile was enriched for actin cytoskeleton, mitochondrial dysfunction and oxidative phosphorylation pathways. CA1, TNNT3, SYNM and MB were overexpressed, and FBLN1 was underexpressed in transforming OLP compared with indolent OLP. Integrin signalling and antigen presentation pathways were enriched in both indolent and transforming OLP compared with NOM. This proteomic study provides potential biomarkers, such as CA1 overexpression, for higher-risk OLP. While further validation studies are needed, we propose that epithelial-mesenchymal transition may be involved in OLP carcinogenesis.

Microenvironment in Oral Potentially Malignant Disorders: Multi-Dimensional Characteristics and Mechanisms of Carcinogenesis

Oral potentially malignant disorders (OPMDs) are a group of diseases involving the oral mucosa and that have a risk of carcinogenesis. The microenvironment is closely related to carcinogenesis and cancer progression by regulating the immune response, cell metabolic activities, and mechanical characteristics. Meanwhile, there are extensive interactions between the microenvironments that remodel and provide favorable conditions for cancer initiation. However, the changes, exact roles, and interactions of microenvironments during the carcinogenesis of OPMDs have not been fully elucidated. Here, we present an updated landscape of the microenvironments in OPMDs, emphasizing the changes in the immune microenvironment, metabolic microenvironment, mechanical microenvironment, and neural microenvironment during carcinogenesis and their carcinogenic mechanisms. We then propose an immuno–metabolic–mechanical–neural interaction network to describe their close relationships. Lastly, we summarize the therapeutic strategies for targeting microenvironments, and provide an outlook on future research directions and clinical applications. This review depicts a vivid microenvironment landscape and sheds light on new strategies to prevent the carcinogenesis of OPMDs.

Langerhans Cells, T Cells, and B Cells in Oral Lichen Planus and Oral Leukoplakia

Although oral lichen planus (OLP) and oral leukoplakia (LPL) have different pathogenetic profiles, both may involve chronic inflammation. The aim of this observational study was to evaluate the inflammatory cell profiles of OLP and LPL. The inflammatory cell infiltrates in patients with OLP and LPL were analyzed for the presence of Langerhans cells (LCs; CD1a), T cells (CD3), and B cells (CD20), as well as for the proliferation marker Ki-67. Biopsied specimens from patients with OLP (N = 14) and LPL without dysplasia (N = 13) were immunohistochemically stained with antibodies directed against CD1a, CD3, CD20, and Ki-67, followed by quantitative analyses. A significant increase in the number of CD3⁺ cells and CD20⁺ cells was found in the submucosa of OLP, as compared to LPL (p < 0.01). Likewise, the number of CD3⁺ cells was significantly higher in the epithelium of OLP than of LPL (p < 0.05). No differences were found in the expression of Ki-67 and the number of CD1a⁺ cells between the two groups. Although an immune response is elicited in both conditions, there are differences at the cellular level between OLP and LPL. A more robust immune activation involving T cells and B cells is seen in OLP. The role of B cells in OLP needs to be further elucidated. Although the number of B cells in LPL is low, their role in the inflammatory response cannot be ruled out.

Whole-Exome Sequencing of Transforming Oral Lichen Planus Reveals Mutations in DNA Damage Repair and Apoptosis Pathway Genes

BACKGROUND

Oral lichen planus confers a 1% risk of transformation to oral squamous cell carcinoma. While prior exome sequencing studies have identified multiple genetic mutations in oral squamous cell carcinoma, mutational analyses of lichen planus-derived OSCC are lacking. We sought to clarify genomic events associated with oral lichen planus transformation.

METHODS

Using rigorous diagnostic criteria, we retrospectively identified patients with non-transforming oral lichen planus (i.e. known to be non-transforming with 5 years of clinical follow-up; n=17), transforming oral lichen planus (tissue marginal to oral squamous cell carcinoma, n=9), or oral squamous cell carcinoma arising in lichen planus (n=17). Gene mutational profiles derived from whole-exome sequencing on fixed mucosal specimens were compared amongst the groups.

RESULTS

The four most frequently mutated genes in transforming oral lichen planus and oral squamous cell carcinoma (TP53, CELSR1, CASP8 and KMT2D) identified 12/17 (71%) of oral squamous cell carcinomas and 5/9 (56%) of transforming oral lichen planus but were absent in non-transforming oral lichen planus. These findings suggest alterations in DNA damage response and apoptosis pathways underlie lichen planus-related oral squamous cell carcinoma transformation and are supported by mutational signatures indicative of DNA damage. We identified other known oral squamous cell carcinoma mutations (TRRAP, OBSCN, LRP2) but also previously unreported mutations (TENM3 and ASH1L) in lichen planus-associated oral squamous cell carcinomas.

CONCLUSIONS

This study characterized patterns of mutational events present in oral lichen planus associated with squamous cell carcinoma, and in squamous cell carcinoma associated with oral lichen planus, but not in non-transforming oral lichen planus.

Optical Imaging in the Diagnosis of OPMDs Malignant Transformation

Oral potentially malignant disorders (OPMDs) are a heterogeneous group of oral lesions with a variable risk of malignant transformation to oral squamous cell carcinoma. The current OPMDs malignant transformation screening depends on conventional oral examination (COE) and is confirmed by biopsy and histologic examination. However, early malignant lesions with subtle mucosal changes are easily unnoticed by COE based on visual inspection and palpation. Optical techniques have been used to determine the biological structure, composition, and function of cells and tissues noninvasively by analyzing the changes in their optical properties. The oral epithelium and stroma undergo persistent structural, functional, and biochemical alterations during malignant transformation, leading to variations in optical tissue properties; optical techniques are thus powerful tools for detecting OPMDs malignant transformation. The optical imaging methods already used to detect OPMDs malignant transformation in vivo include autofluorescence imaging, narrowband imaging, confocal reflectance microscopy, and optical coherence tomography. They exhibit advantages over COE in detecting biochemical or morphologic changes at the molecular or cellular level in vivo; however, limitations also exist. This article comprehensively reviews the various real-time in vivo optical imaging methods used in the adjunctive diagnosis of OPMDs malignant transformation. We focus on the principles of these techniques, review their clinical application, and compare and summarize their advantages and disadvantages. Finally, we conclude with a discussion of current challenges and future directions of this field.

Substance P and Neurokinin 1 Receptor in Chronic Inflammation and Cancer of the Head and Neck: A Review of the Literature

Head and neck cancer is a growing worldwide public health problem, accounting for approximately 1,500,000 new cases and 500,000 deaths annually. Substance P (SP) is a peptide of the tachykinin family, which has roles related to a large number of physiological mechanisms in humans. The implications of SP in carcinogenesis have recently been reported through the stimulation of the neurokinin 1 receptor (NK1R), or directly, through the effects derived from the constitutive activation of NK1R. Consequently, SP/NK1R seems to play relevant roles in cancer, upregulating cell proliferation, cell migration and chronic inflammation, among other oncogenic actions. Furthermore, there is growing evidence pointing to a central role for SP in tumour progression, singularly so in laryngeal and oral squamous cell carcinomas. The current narrative review of the literature focuses on the relationship between the SP/NK1R system and chronic inflammation and cancer in the head-and-neck region. We described a role for SP/NK1R in the transition from chronic inflammation of the head and neck mucosa, to preneoplastic and neoplastic transformation and progression.

Comparative efficacy of topical aloe vera and low-level laser therapy in the management of oral lichen planus: a randomized clinical trial

This randomized clinical trial aimed to compare the efficacy of topical aloe vera with low-level laser therapy in patients with oral lichen planus (OLP). A randomized, parallel arm, single-blind study comprising of 60 patients with OLP was randomly divided into two groups. Group A was given topical aloe vera extract gel applied thrice daily for 2 months, and group B was given low-level laser therapy (LLLT) at 980 nm twice weekly for 2 months. Both groups were followed up for 9 months. Patients were assessed for various parameters according to the Escudier scale at baseline, after treatment at 9 months. Results were assessed using the McNemar-Bowker test and the Mann-Whitney U test. Both individual groups showed significant (p < 0.05) results at the end of the treatment period (0-2 months) and the follow-up period (2-7 months). Intergroup comparison showed significant results in the laser group (reduction of VAS by 44.1%, site score by 24.6%, and activity score by 50%) as compared with the aloe vera group (reduction of VAS by 26.7%, site score by 9.2%, and the activity score by 26%) in the treatment period. In the follow-up period, both groups showed insignificant differences in comparison to each other. Within the limitations of the study, LLLT was more effective as compared with topical aloe vera in managing oral lichen planus during the active treatment time, while both were equally effective during the follow-up period. The clinical study was registered under the Clinical Trials Registry India with the registration number CTRI/2018/04/013147.

Metabolomics and Transcriptomics Analysis on Metabolic Characteristics of Oral Lichen Planus

Objective

To explore metabolic biomarkers related to erosive and reticulated oral lichen planus (OLP) by non-targeted metabolomics methods and correlate metabolites with gene expression, and to investigate the pathological network pathways of OLP from the perspective of metabolism.

Methods

A total of 153 individuals were enrolled in this study, including 50 patients with erosive oral lichen planus (EOLP), 51 patients with reticulated oral lichen planus (ROLP), and 52 healthy controls (HC). The ultra-high-performance liquid chromatography quadrupole-Orbitrap high-resolution accurate mass spectrometry (UHPLC/Q-Orbitrap HRMS) was used to analyze the metabolites of 40 EOLP, 40 ROLP, and 40 HC samples, and the differential metabolic biomarkers were screened and identified. The regulatory genes were further screened through the shared metabolites between EOLP and ROLP, and cross-correlated with the OLP-related differential genes in the network database. A “gene-metabolite” network was constructed after finding the key differential genes. Finally, the diagnostic efficiency of the biomarkers was verified in the validation set and a diagnostic model was constructed.

Result

Compared with HC group, a total of 19 and 25 differential metabolites were identified in the EOLP group and the ROLP group, respectively. A total of 14 different metabolites were identified between EOLP and ROLP. Two diagnostic models were constructed based on these differential metabolites. There are 14 differential metabolites shared by EOLP and ROLP. The transcriptomics data showed 756 differentially expressed genes, and the final crossover network showed that 19 differential genes were associated with 12 metabolites. Enrichment analysis showed that alanine, aspartate and glutamate metabolism were closely associated with the pathogenesis of OLP.

Conclusion

The metabolic change of different types of OLP were clarified. The potential gene perturbation of OLP was provided. This study provided a strong support for further exploration of the pathogenic mechanism of OLP.

Evaluation of Mast Cells in Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma

Background

Oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs) are epithelial-derived pathologies which share inflammation as a common initial pathogenic-inducing state. Mast cell is a key immune modulating cell which is primarily involved in initiation and propagation of inflammation. The role of mast cell in OPMDs and OSCC has been an established fact; however, its definitive pathogenic correlation is still under study. The objective of the study was to evaluate the number of mast cell in OPMDs and OSCC using special stain correlating its probable role as a promoter or retarder of OSCC.

Materials and Methods

Forty-five archival histopathologically confirmed cases each of OPMD and OSCC were studied for mast cells using toluidine blue and Alcian blue-safranin stain and compared with 10 normal oral mucosal tissues. Comparisons between the mast cells count was also performed between the two special stains.

Results

Among 100 cases, 67% were males and 33% were females. The mean age was 41.68 ± 13.39; 55.06 ± 12.55; and 18.4 ± 2.54 years for OPMDs, OSCC, and normal, respectively. A statistically significant increase in mast cells among OPMDs (9.88 ± 7.9) and OSCC (6.711 ± 3.94) was observed compared to normal oral mucosa. The mast cell count reduced among OSCC in comparison to OPMDs which was significant as well. The mean mast cell count for Alcian blue-safranin stain was higher than toluidine blue stain.

Conclusion

There is a decrease in mean mast cell count from OPMDs to OSCC which is suggestive of protective role of mast cell. Proper quantification of mast cells using specific stains can guide to define prognosis in oral potentially malignant disorders and oral cancer.

Elevation of Serum SSCCAII in Cutaneous and Oral Lichen Planus: Missing Link for Hidden Carcinogenic Potential?

Context:

Lichen planus (LP) is an immune mediated inflammatory condition. SCCAII is a useful biomarker reflecting Th17 type inflammation. It is also a tumour marker, especially for Squamous cell carcinoma (SCC) Mechanism of carcinogenesis in LP is still unknown. Chronic inflammation may facilitate the development of cellular clones in the epidermis.

Aims:

Estimation of serum level of SCCA II in patients with cutaneous and oral LP (OLP) to detect its role in LP pathogenesis, and to reveal the missing link in understanding mechanism of carcinogenesis in LP.

Methods and Material:

A case control study, where 100 subjects were included; 80 LP patients (40 cutaneous & 40 oral) and 20 apparently healthy controls. We obtained an informed written consent from each subject prior the participation. Cutaneous and oral LP were diagnosed clinically, SCCA II level was measured by ELISA technique.

Statistical analysis used:

Statistical analysis was done using SPSS vs.25. (IBM, Armonk, New York, United states). Numerical data was summarized as means and standard deviations or medians and ranges.

Results:

Median SSCCAII level was significantly higher in LP cases compared to controls (P < 0.001) and was significantly higher in patients with OLP compared to patients with cutaneous LP (P ≤ 0.001). Post hoc analysis revealed that median SSCCAII was significantly higher in patients with ulcerative type compared to both reticular type and others. It was also significantly higher in patients with actinic type compared to both hypertrophic type and classic type. Median SSCCAII was significantly higher in patients with ulcerative OLP compared to actinic LP (P < 0.001).

Conclusions:

Our study revealed that serum SCCAII level was higher in patients with cutaneous and OLP. This might be linked to the pathogenesis of LP, especially actinic and erosive OLP. SCCAII level could facilitate the screening and early detection of patients at risk, a potential alarm to launch accurate assessment and continue follow up of cutaneous as well as O LP patients.

Oral Lichen Planus: risk factors of malignant transformation and follow up. Ten years retrospective study

Background

Oral Lichen Planus (OLP) is an inflammatory chronic disease. Modified World Health Organization (WHO) diagnostic criteria (2003) suggest diagnosing OLP both clinically and histologically. Furthermore, it is known the potential of malignant transformation of OLP, especially those affecting mucosa. Aims of this retrospective study on 100 patients were i) to estimate the timing of transformation of OLP lesions in OSCC in a cohort of patients observed between 2008 and 2018; ii) to assess risk factors of OLP patients diagnosed with OSCC; iii) to analyse forms of OLP evolved in cancer.

Material and Methods

A database of 100 patients diagnosed with OLP was evaluated and clinical, histological features of lesions, habits of patients and systemic diseases were analysed in a follow up ranged between 5 and 10 years.

Results

Mean time of malignant transformation was 31,62± 18,26 months; however, 4 malignant transformations out of 8 occurred about after 4 years of observation. Furthermore, Odds ratios for risk factors showed an association between malignant transformation and location.

Conclusions

More focused attention on follow-up scheduling and designing could be a valuable resource in early diagnosis and cancer prevention in OLP patients.

Key words:Oral Lichen Planus, Oral Cancer, Malignant transformation, risk factors.

The critical role of piperamide derivative D4 in the regulation of inflammatory response by the microglia and astrocytic glial cells

Acute and chronic inflammation in the central nervous system plays a critical role in the development of neurodegenerative disorders. Various pro-inflammatory cytokines, chemokines, and enzymes such as TNF-α, IL1-β, IL-6, COX-1, COX-2, iNOS, IKK, and inducible nitric oxide are expressed in several signalling pathways, and mediate the neuroinflammatory process. ROS and NF-kB nuclear translocation are the two fundamental pathways involved in neuroinflammatory pathogenesis in neuronal and glial cells. In recent years several compoundswere designed to affect the neuroinflammation and suppress neurodegenerative process. Derivatives of natural products (NPs) attract the most attention of drug developers and industries due to their safety and lesser side effects in comparison with generic drugs. One of the most well-known NP is piperine, which is a yellow crystalline alkaloid extracted from black and white pepper. Recently, we developed a novel piperine derivative (((2E,4E)-5-(benzo[d][1,3]dioxol-5-yl)-N-(4-(hydroxymethyl)phenyl)penta-2,4-dienamide, D4) to enhance the specificity and efficacy of the base molecule. Next, we evaluated the potential anti-inflammatory properities of D4 in CHME3 and SVG cell-lines corresponding to human microglia and astrocytes, respectively. Our results indicated that D4 inhibited NF-kB translocation pathway, and significantly reduced transcript and protein levels of pro-inflammatory cytokines in comparison with Aspirin, as a well-known non-selective NSAID. Furthermore, in silico study showed excellent D4 bioavailability in oral administration. The results of the present study suggest a novel molecule with high anti-neuroinflammatory potency for further pre-clinical tests and pharmacological drug investigation.

Immunoexpression of Apoptosis and Cell-cycle Arrest Markers in Oral Lichen Planus

The expression pattern of a panel of 5 molecular markers (p53, cyclin D1, Ki-67, BCL-2, and BAX) was studied in samples from patients with oral lichen planus (OLP) and normal oral mucosa (NOM) of healthy controls to investigate the implications of cell cycle and apoptosis in OLP. The 59 OLP and 16 NOM biopsies were stained by an inmunoperoxidase technique for p53, cyclin D1, Ki-67, BCL-2, and BAX and assessed microscopically for semiquantitative analysis. Positivity for BCL-2 and Ki-67 was significantly more frequent in NOM than in OLP (P<0.05). p53 levels were upregulated in atrophic/erosive clinical presentations when compared with reticular presentations and in cases with discontinued inflammatory infiltrate. Multivariate analysis through logistic regression showed that BCL-2 in OLP versus NOM was the only significantly altered marker in the present cohort (adjusted odds ratio=12.42; 95% confidence interval: 2.5-61.65; P=0.002). The cell patterns in OLP and NOM are distinct according to the present molecular markers panel. The presence of BCL-2 altered expression may be related to various molecular pathways that connect/link this condition to other autoimmune disorders and also may be involved in complex roles that evoke malignant transformation of OLP.

Nano Drug Delivery in Treatment of Oral Cancer, A Review of the Literature

Oral Cancer (OC) is a serious and growing problem which constitutes a huge burden on people in more and less economically developed countries alike. The scenario is clearly depicted from the increase in the expected number of new cases in the US diagnosed with OC from 49,670 people in 2016, to 49,750 cases in 2017. The situation is even more alarming in India, with 75,000 to 80,000 new cases being reported every year, thus making it the OC capital of the world. Leukoplakia, erythroplakia, oral lichen planus, oral submucous fibrosis, discoid lupus erythmatosus, hereditary disorders such as dyskeratosis congenital and epidermolisys bullosa are highlighted by WHO expert working group as the predisposing factors increasing the risk of OC. Consumption of tobacco and alcohol, genetic factors, and human papilloma virus are assigned as the factors contributing to the aetiology of OC. On the other hand, pathogenesis of OC involves not only apoptosis but also pain, inflammation and oxidative stress. Inspite of current treatment options (surgery, radiotherapy, and chemotherapy), OC is often associated with recurrence and formation of secondary primary tumours resulting in poor overall survival rates (∼50%). The intervention of nano technology-based drug delivery systems as therapeutics for cancers is often viewed as a cutting edge for technologists. Though ample literature on the usefulness of nano-coutured cancer therapeutics, rarely any product is in pipeline. Yet, despite all the hype about nanotechnology, there are few ongoing trials. This review discusses the current and future trends of nano-based drug delivery for the treatment of OC.

Omega-3 polyunsaturated fatty acids: a promising approach for the management of oral lichen planus

BACKGROUND

Oral lichen planus (OLP) is a T-cell-mediated inflammatory disease with a risk of malignant transformation. Although the etiology of OLP is still uncertain, growing evidence suggests that oral microbiota, antigen-specific, and non-specific mechanisms are involved in the pathogenesis of OLP. Antigen-specific mechanisms include antigen presentation, T-cell activation, nuclear factor-kappa B signaling pathway, and cytokine secretion, while non-specific mechanisms consist of matrix metalloproteinases (MMP)-9 upregulation, psychological pressure, oxidative damage, aberrant expression of microRNAs (miRNAs), and autophagy. Till now, there is no cure for OLP, and the main purpose of OLP therapy is symptomatic control.

FINDING

Seafood and its derivative omega-3 polyunsaturated fatty acids (n-3 PUFAs) can suppress antigen presentation, T-cell activation, and nuclear factor-kappa B signaling pathway, modulate the overexpressed inflammatory cytokines, inhibit the expression of MMP-9, as well as regulate the expression of miRNAs and autophagy. And they are possible agents for ameliorating psychological disorder and oxidative damage. Moreover, n-3 PUFAs supplementation has a beneficial effect on preventing tumorigenesis.

CONCLUSION

n-3 PUFAs consumption may provide a non-toxic, inexpensive administration for OLP.

Sex Hormones and Inflammation Role in Oral Cancer Progression: A Molecular and Biological Point of View

Oral cancers have been proven to arise from precursors lesions and to be related to risk behaviour such as alcohol consumption and smoke. However, the present paper focuses on the role of chronic inflammation, related to chronical oral infections and/or altered immune responses occurring during dysimmune and autoimmune diseases, in the oral cancerogenesis. Particularly, oral candidiasis and periodontal diseases introduce a vicious circle of nonhealing and perpetuation of the inflammatory processes, thus leading toward cancer occurrence via local and systemic inflammatory modulators and via genetic and epigenetic factors.

The effect of smoking on clinical presentation and expression of TLR-2 and CD34 in Oral lichen Planus patients: clinical and immunohistochemical study

BACKGROUND

Oral lichen planus is a chronic inflammatory disease which is considered as a potential precancerous condition. Numerous studies have confirmed that inflammation is a strong risk factor for cancer development. Smoking is associated with potentially malignant disorders of the oral and oropharyngeal mucosa. The adverse consequences of smoking in various pathologies are mediated by its effects on the immune-inflammatory system. Little is known about the influence of cigarette smoke content on the course of OLP and inflammatory response.

METHODS

Twenty oral lichen planus smoker patients, 20 oral lichen planus non-smoker patients and 20 control patients were included in this work. Pain and clinical scores were calculated for each patient. Image analysis to calculate area percent for TLR-2 and CD34 immuno-expression was performed. Data was tabulated and statistically analyzed.

RESULTS

The present study showed no statistically significant difference in clinical and pain scores between the smoker and non-smoker groups. However, there was a significant difference in area percent values for TLR-2 and CD34 immuno-expression between the smoker and the non-smoker groups.

CONCLUSION

Smoking enhanced TLR-2 and CD34 expression in OLP which are considered as inflammatory mediators and are contributing factors in the pathogenesis of oral lichen planus.

Validity of serum amyloid A and HMGB1 as biomarkers for early diagnosis of gastric cancer

Background and aim

Gastric carcinomais a frequent neoplasm with poor outcome, and its early detection would improve prognosis. This study was designed to evaluate the possible use of new biomarkers, namely SAA and HMGB1, for early diagnosis of gastric cancer.

Methods

A total of 100 patients presenting with gastric symptoms were included. All patients underwent upper endoscopic evaluation, histopathological diagnosis and serum CEA, SAA, and HMGB1 measurements.

Results

Patients were classed endoscopically with neoplastic, inflammatory, and normal-appearing gastric mucosa: 50, 25, and 25 patients, respectively. Histologically, half the patients had chronic gastritis and the remaining cases gastric carcinoma of diffuse (n=28) or intestinal (n=22) type. SAA at cutoff of 18.5 mg/L had the best validity to differentiate gastritis from gastric carcinoma, with AUC, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 0.99, 98%, 100%, 100%, and 98%, respectively, followed by HMGB1 at cutoff of 14.5 pg/μL, with AUC, sensitivity, specificity, PPV, and NPV of 0.91, 70%, 96%, 94.6%, and 76.2%, respectively. Sensitivity, specificity, PPV, and NPV of serum CEA at cutoff of 2.9 ng/mL to differentiate gastritis from gastric carcinoma were 42%, 72%, 60%, and 55.4%, respectively, with AUC of 0.53. Nonetheless, higher serum levels of both SAA and HMGB1 reflected higher tumor grade (P=0.027 and P=0.016, respectively) and advanced tumor stage (P-OBrk-0.001 for both).

Conclusion

Serum levels of both SAA and HMGB1 could be of great value for early diagnosis of gastric carcinoma, comparable to the diagnostic role of serum CEA, which is not valid for early diagnosis of gastric cancer.

Neutrophil extracellular traps (NETs) formation induced by TGF-β in oral lichen planus - Possible implications for the development of oral cancer

Oral Potentially Malignant Disorders (OPMDs) including Oral Lichen Planus (OLP) are associated with risk of transformation to oral squamous cell carcinoma (OSCC). Available data show that innate immune cells involving polymorphonuclear neutrophils (PMNs) with their ability to neutrophil extracellular traps (NETs) formation are likely to be directly involved in development of cancer. Examination of NETs generation by TGF-β - induced neutrophils of OLP patients showed increased amounts of traps with MPO, H3Cit and cfDNA, known to be released with NETs. The presence of excessive amounts of NETs components may lead to numerous adverse consequences associated with potential transformation to OSCC. Bacterial-related infection may enhance the NETs formation and lead to consequences resulting from the excessive number of individual elements of these networks. It is likely that regulating NETs release by the flavonoids presented herein may be beneficial not only for inhibiting OLP development, but also in reducing risk of transformation to OSCC.

Metabolic changes during malignant transformation in primary cells of oral lichen planus: Succinate accumulation and tumour suppression

Oral squamous cell carcinoma (OSCC) is usually diagnosed at late stages, which leads to high morbidity. There are evidence that chronic inflammation (eg oral lichen planus [OLP]) was a risk factor of OSCC, but often misdiagnosed or ignored until invasion and metastasis. By applying precision medicine, the molecular microenvironment variations and relevant biomarkers for the malignant transformation from OLP to OSCC can be fully investigated. Several studies pointed out that the metabolic pathway were suppressed in OSCC. However, it remains unclear how the systemic profile of the metabolites change during the malignant transformation. In this study, we examined and compared the mucosa samples from 11 healthy individuals, 10 OLP patients and 21 OSCC patients. Based on the results, succinate, a key metabolite of the tricarboxylic acid cycle pathway, was accumulated in the primary cultured precancerous OLP keratinocytes and OSCC cells. Then, we found that succinate activated the hypoxia‐inducible factor‐1 alpha (HIF‐1α) pathway and induced apoptosis, which could also be up‐regulated by the tumour suppressor lncRNA MEG3. These results suggested the critical roles of succinate and MEG3 in the metabolic changes during malignant transformation from OLP to OSCC, which indicated that succinate, HIF1α and downstream proteins might serve as new biomarkers of precancerous OLP for early diagnosis and therapeutic monitoring. In addition, succinate or its prodrugs might become a potential therapy for the prevention or treatment of OSCC.

Inferring novel genes related to oral cancer with a network embedding method and one-class learning algorithms

Oral cancer (OC) is one of the most common cancers threatening human lives. However, OC pathogenesis has yet to be fully uncovered, and thus designing effective treatments remains difficult. Identifying genes related to OC is an important way for achieving this purpose. In this study, we proposed three computational models for inferring novel OC-related genes. In contrast to previously proposed computational methods, which lacked the learning procedures, each proposed model adopted a one-class learning algorithm, which can provide a deep insight into features of validated OC-related genes. A network embedding algorithm (i.e., node2vec) was applied to the protein-protein interaction network to produce the representation of genes. The features of the OC-related genes were used in the training of the one-class algorithm, and the performance of the final inferring model was improved through a feature selection procedure. Then, candidate genes were produced by applying the trained inferring model to other genes. Three tests were performed to screen out the important candidate genes. Accordingly, we obtained three inferred gene sets, any two of which were different. The inferred genes were also different from previous reported genes and some of them have been included in the public Oral Cancer Gene Database. Finally, we analyzed several inferred genes to confirm whether they are novel OC-related genes.

Down-regulation of miRNA-27b-3p suppresses keratinocytes apoptosis in oral lichen planus

Oral lichen planus (OLP) is considered a precancerous lesion with no known cure. Recent studies reported that abnormal regulation of apoptosis was involved in the pathogenesis of OLP. Next generation sequencing was used to screen the candidate microRNAs and genes in biopsies from patients with OLP and healthy mucosa. Human oral keratinocytes were transfected into the related oligonucleotides of miR‐27b‐3p/cyclophilin D and their control groups. Apoptosis was detected by TdT‐mediated dUTP nick end labelling and flow cytometry. The levels of mRNA and protein were detected by quantitative PCR, Western blots, and enzyme‐linked immunosorbent assays, respectively. Luciferase assays were performed to detect the luciferase activities of miR‐27b‐3p and cyclophilin D. Here, we showed that basal epithelium apoptosis was reduced and the miR‐27b‐3p levels were decreased in clinical OLP samples. We also found that down‐regulation of miR‐27b‐3p inhibited epithelial keratinocyte apoptosis by up‐regulating cyclophilin D expression. Moreover, cyclophilin D increased the protein stability of Bcl2 through direct binding, and Bcl2 suppressed caspase9/3 activation and cytochrome C release. Taken together, these data showed that miR‐27b‐3p regulated keratinocyte apoptosis through cyclophilin D/Bcl2 signalling, suggesting the miR‐27b‐3p regulated the pathogenesis of OLP.

How I treat refractory chronic graft-versus-host disease

Approximately 35% to 50% of patients otherwise cured of hematologic malignancies after allogeneic hematopoietic stem cell transplantation will develop the pleomorphic autoimmune-like syndrome known as chronic graft-versus-host disease (cGVHD). Since in 2005, National Institutes of Health (NIH) consensus panels have proposed definitions and classifications of disease to standardize treatment trials. Recently, the first agent was approved by the US Food and Drug Administration for steroid-refractory cGVHD. Despite these advances, most individuals do not achieve durable resolution of disease activity with initial treatment. Moreover, standardized recommendations on how to best implement existing and novel immunomodulatory agents and taper salvage agents are often lacking. Given the potential life-threatening nature of cGVHD, we employ in our practice patient assessment templates at each clinic visit to elucidate known prognostic indicators and red flags. We find NIH scoring templates practical for ongoing assessments of these complex patient cases and determination of when changes in immunosuppressive therapy are warranted. Patients not eligible or suitable for clinical trials have systemic and organ-directed adjunctive treatments crafted in a multidisciplinary clinic. Herein, we review these treatment options and offer a management and monitoring scaffold for representative patients with cGVHD not responding to initial therapy.

Arecoline N-oxide regulates oral squamous cell carcinoma development through NOTCH1 and FAT1 expressions

Areca nut has been evaluated as a group I carcinogen to humans. However, the exact compounds of areca nut causing oral cancer remain unproven. Previous findings from our lab revealed that arecoline N-oxide (ANO), a metabolite of arecoline, exhibits an oral fibrotic effect in immune-deficient NOD/SCID mice. The aim of this study is to investigate the oral potentially malignant disorders (OPMD) inductive activity between areca-alkaloid arecoline and its metabolite ANO in C57BL/6 mice. Our findings show that ANO showed higher activity in inducing hyperplasia with leukoplakia and collagen deposition in C57BL/6 mice compared with the arecoline treated groups. Importantly, immunohistochemical studies showed significant upregulation of NOTCH1, HES1, FAT1, PCNA, and Ki67 expressions in the pathological hyperplastic part. In addition, in vitro studies showed that upregulation of NOTCH1 and FAT1 expressions in ANO treated HGF-1 and DOK cell models. We found that NOTCH1 regulates TP53 expression from NOTCH1 knockdown oral cancer cells. The DNA damage was significantly increased after arecoline and ANO treatment. Further, we found that arecoline-induced H2AX expression was regulated by FMO3. Altogether, our findings show that ANO exhibited higher toxicity in OPMD activity and play a significant role in the induction of areca nut mediated oral tumorigenesis.

Role of miR-155 in immune regulation and its relevance in oral lichen planus

Oral lichen planus (OLP) is a chronic mucosal inflammatory disease. The World Health Organization has described it as a potentially malignant condition. The pathogenesis of OLP remains to be fully elucidated, but extensive evidence suggests that immunologic and inflammatory factors have important roles. MicroRNAs (miRs), which are small non-coding RNAs, have been reported to be involved in OLP. In particular, miR-155 is significantly upregulated in patients with OLP. miR-155 has numerous functions and is closely linked to inflammation and immune system regulation. However, in-depth studies of the mechanisms via which miR-155 is involved in OLP are currently insufficient. Considering the close association between miR-155 and immune regulation as well as the importance of immune factors in OLP, the role of miR-155 in the immune system was herein summarized with a focus on OLP. The present review provides a basis for further study of the molecular mechanisms underlying the development and progression of OLP.

Dietary Fatty Acids and Other Nutrients in Relation to Inflammation and Particularly to Oral Mucosa Inflammation. A Literature Review

Oral mucosa is site of inflammatory process development. When they are chronic, they provide a microenvironment based on cytokines and inflammatory mediators that contribute to cancer initiation, progression, invasion, and metastasis. Certain dietary fatty acids (FAs) have immunomodulatory, inflammatory, and antiinflammatory effects. This review examined the literature on inflammation, mainly referred to the oral mucosa, and its association with dietary FAs and other nutrients. A Pubmed search of studies published in English until June 2018 was carried out. N-3 FAs have shown immunomodulatory and antiinflammatory activity in certain human diseases. These FAs and their mediators may inhibit inflammation, angiogenesis, and cancer via multiple mechanisms. Studies on cellular models of murine and human intestinal mucosa indicate association between dietary n-3 FA intake and the inflammatory state of mucosa membranes. Nevertheless scarce information on the association between dietary FAs and oral inflammation could be found. Based on the evidence, we hypothesize that n-3 FAs reduce the oral mucosa inflammation thus decreasing the risk of developing precancerous lesions and cancer. Molecular and clinical studies referred to this topic should be carried out as a contribution to the oral cancer prevention.

A systematic review and meta-analysis study of salivary and serum interleukin-8 levels in oral lichen planus

Introduction

Interleukin-8 (IL-8) is an important mediator of the host response to injury and inflammation that the clinical severity of oral lichen planus (OLP) is associated with elevated serum IL-8 levels.

Aim

To evaluate serum and salivary IL-8 levels of the OLP patients compared with the healthy controls and measurement of IL-8 level in which sample is more valuable.

Material and methods

Five databases including PubMed/Medline, Web of Science, Science Direct, Cochrane Library and Scopus were searched for the evaluation of serum and salivary IL-8 levels of the OLP patients compared with the healthy controls in the English abstract. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used for checking the quality of the studies. A random-effect model was used for calculating the mean difference (MD) and 95% confidence intervals (CIs).

Results

Nine studies were included in the meta-analysis. The pooled estimate showed a significant difference between two groups that the salivary IL-8 level in the OLP patients was higher than the healthy controls (MD = 766.32 pg/ml, 95% CI: 394.90-1137.75; p < 0.0001) and also the serum IL-8 level in the OLP patients was higher than the healthy controls (MD = 8.38 pg/ml, 95% CI: 3.32-13.44; p = 0.001).

Conclusions

The higher levels of IL-8 in saliva compared with serum suggest that measurement of this marker in saliva may be more useful than serum measurements for determining therapeutic and diagnostic aims.

Prevalence of hepatitis C virus infection and its impact on the prognosis of head and neck cancer patients

OBJECTIVE

Several studies have shown a higher prevalence of hepatitis C virus (HCV) infection among patients with head and neck cancer (HNC) compared to the general population. In Brazil, the prevalence of HCV infection is considered low (1.38%). The aim of this study was to determine HCV prevalence and how this can modify outcomes of patients with HNC.

STUDY DESIGN

Retrospective cohort.

METHODS

Patients with a diagnosis of malignant neoplasm in the head and neck (HN) region and who had serology performed for HCV were included. Patients were classified into two groups: head and neck squamous cell carcinoma (HNSCC) and other head and neck malignant neoplasms (OHNMN). Descriptive statistics were performed for all variables of interest. Means were compared using ANOVA and proportions using chi-square tests. Survival data were compared by Kaplan-Meier curves and log-rank test.

RESULTS

Global HCV prevalence in patients with HNC was 7.8%, reaching 12.8% in HNSCC and 3.4% in OHNMN (p = 0.003). There was a higher risk of developing a second primary neoplasm in HNSCC compared to OHNMN patients (20.6% versus 4.6%; p = 0.001). The mean survival was not different between HCV-positive and HCV-negative patients (6.0 years versus 6.6 years, respectively, p = 0.516).

CONCLUSION

The prevalence of HCV infection was higher in HNC patients compared to the general Brazilian population. It seems reasonable to consider that HCV infection is associated with an increased risk of HNC, but HCV infection does not worsens the prognosis of HNC patients.

Black pepper and its bioactive constituent piperine: promising therapeutic strategies for oral lichen planus

Oral lichen planus (OLP) is a common T cell-mediated chronic inflammatory disease with malignant potential and unclear etiology. The present study suggests that antigen-specific mechanisms in which dentritic cells, T lymphocytes and NF-κB signaling pathway play critical roles, are involved in the pathogenesis of OLP. Additionally, it has been indicated that altered expression of cyclooxygenase 2 (COX-2) and imbalanced oxidant-antioxidant status as well as psychological issue may act as promoters to the development of OLP. Therapies for OLP are primarily aimed to control symptoms and a specific cure is not yet available. Black pepper and its principle bioactive compound piperine have been reported to possess remarkable pharmacological activities. Not only has piperine been evidenced to exhibit repressive effects on the maturation of dentritic cells, the proliferation, activation and function of T lymphocytes as well as the NF-κB signaling pathway, but also to suppress the overproduction of COX-2 and weaken the oxidative stress. Furthermore, piperine might be a possible agent for alleviating psychological disorders and preventing carcinogenesis. Given all these into consideration, piperine may be a novel and effective therapeutic strategy for OLP.

Evaluation of mast cells in oral premalignant and malignant lesions: A histochemical study

Introduction:

Oral leukoplakia, oral submucous fibrosis, and oral lichen planus are the precancerous or potentially malignant lesions and conditions whereas oral squamous cell carcinoma (OSCC) is a cancerous or malignant lesion of the oral cavity. They have characteristic clinical and histopathological features. These diseases not only originate from epithelium but also associated with chronic inflammation juxta-epithellialy. Mast cells present in the connective tissue stroma and release pro-inflammatory and mitogenic cytokines. These functions of mast cells contribute and enhance the pathogenesis translation of diseases.

Aim:

The study was done to histologically evaluate the number of mast cells in oral epithelial dysplasia and OSCC and compare it with normal oral mucosa (NOM).

Materials and Methods:

Forty-five cases each of oral dysplasia, OSCC and ten cases of NOM were studied for mast cell number using toluidine blue.

Results:

There was a highly significant increase of mast cells in oral epithelial dysplasia on comparison with OSCC whereas there was only a significant increase in mast cells in OSCC on comparison with NOM.

Conclusion:

The literature has proven that mast cells can be an indicator of increased angiogenesis and hence can help in the prediction of carcinogenesis, its progression, and also the prognosis of the malignant lesions.

Correlation between tissue expression of microRNA-137 and CD8 in oral lichen planus

OBJECTIVES

Oral lichen planus (OLP) is a chronic, inflammatory condition, classified by the World Health Organization as a premalignant lesion. We performed this study to evaluate the correlation between microRNA-137 (miR-137) and CD8 oral tissue expression in OLP patients.

MATERIALS AND METHODS

Twenty OLP patients [classified into three groups: (a) papular, reticular, or plaque; (b) atrophic; and (c) erosive] and 20 healthy controls were subjected to biopsy of the oral mucosa. To evaluate CD8 tissue expression, we performed immunohistochemical examination, followed by immunostaining and computerized quantification. The expression of miR-137 was evaluated using real-time quantitative PCR. We used SPSS software (version 15 for windows) to perform the statistical analysis.

RESULTS

Our analysis showed an increased tissue expression of CD8 (p < 0.01) and reduced expression of miR-137 (p < 0.001) in OLP patients, compared to the control group. Moreover, there was a statistically significant difference (p = 0.001) between OLP subgroups in terms of CD8 tissue expression [highest in erosive OLP and lowest in papular/reticular/plaque OLP]. However, these subgroups showed no significant difference (p = 0.168) in terms of miR-137 expression. A negative correlation (p < 0.05) between tissue expression of miR-137 and CD8 was noted with a varying correlation coefficient in different OLP subgroups (-0.250 in erosive OLP, -0.491 in atrophic OLP and -0.616 in papular/reticular/plaque OLP).

CONCLUSIONS

Our findings indicate reduced expression of miR-137 and a reverse correlation between tissue expression of miR-137 and CD8 in the oral mucosa of OLP patients.

CLINICAL RELEVANCE

Future studies should investigate the therapeutic potential of miR-137 overexpression in OLP patients.

Crosstalk between DNA Damage and Inflammation in the Multiple Steps of Carcinogenesis

Inflammation can be induced by chronic infection, inflammatory diseases and physicochemical factors. Chronic inflammation is estimated to contribute to approximately 25% of human cancers. Under inflammatory conditions, inflammatory and epithelial cells release reactive oxygen (ROS) and nitrogen species (RNS), which are capable of causing DNA damage, including the formation of 8-oxo-7,8-dihydro-2'-deoxyguanosine and 8-nitroguanine. We reported that 8-nitroguanine was clearly formed at the sites of cancer induced by infectious agents including Helicobacter pylori, inflammatory diseases including Barrett's esophagus, and physicochemical factors including asbestos. DNA damage can lead to mutations and genomic instability if not properly repaired. Moreover, DNA damage response can also induce high mobility group box 1-generating inflammatory microenvironment, which is characterized by hypoxia. Hypoxia induces hypoxia-inducible factor and inducible nitric oxide synthase (iNOS), which increases the levels of intracellular RNS and ROS, resulting DNA damage in progression with poor prognosis. Furthermore, tumor-producing inflammation can induce nuclear factor-κB, resulting in iNOS-dependent DNA damage. Therefore, crosstalk between DNA damage and inflammation may play important roles in cancer development. A proposed mechanism for the crosstalk may explain why aspirin decreases the long-term risk of cancer mortality.

A genome-wide association scan of biological processes involved in oral lichen planus and oral squamous cell carcinoma

BACKGROUND

In this study, the molecular mechanisms underlying malignant transformation from oral lichen planus (OLP) to oral squamous cell carcinoma (OSCC) were examined.

METHODS

High-throughput sequencing of long noncoding RNAs (lncRNAs) and mRNAs of normal subjects and patients with OLP and OSCC was conducted. RNA-seq reads were mapped, lncRNA and mRNA transcripts were assembled, and expression levels were estimated. The targets of lncRNAs were predicted. Finally, Gene Ontology (GO) and pathway enrichment analyses of differentially expressed genes (DEGs) and lncRNA targets were performed.

RESULTS

High-quality sequence data were generated and the mapping ratios for OSCC, normal, and OLP samples were high. In total, 820, 656, and 582 DEGs were obtained from OPL vs. normal, OSCC vs. normal, and OSCC vs. OPL, respectively. A total of 1721 known lncRNAs and 133 predicted lncRNAs and targets were obtained. Keratinization was significantly enriched by OSCC-related DEGs, but not OPL-related DEGs. The pathway of olfactory transduction was enriched by OPL- and OSCC-related DEGs. Defense response to virus and viral carcinogenesis were enriched by DEGs and lncRNA targets in all comparisons. GO term related to the metabolic process was enriched by lncRNA targets in the OPL vs normal comparison, and antigen processing and presentation via MHC class I was significantly enriched by lncRNA targets in the other 2 comparisons.

CONCLUSION

Keratinization and MHC class I antigen processing and presentation were activated during the malignant transformation from OLP to OSCC. Additionally, the olfactory transduction pathway may be important for OSCC.

Oral squamous cell carcinoma: Focusing on interprofessional collaboration

Incidence of oral cancer is rising, and often, cases are not discovered until the cancer has metastasized to the lymphatic system. Most oral cancers are squamous cell carcinomas associated with high mortality. This article reviews oral squamous cell carcinoma relevant to primary care practice focusing on an interprofessional approach to care.

Malignant transformation of oral lichen planus and oral lichenoid lesions: A meta-analysis of 20095 patient data

OBJECTIVES

For over a century, a heated debate existed over the possibility of malignant transformation of oral lichen planus (OLP). We performed this meta-analysis to evaluate the malignant potential of OLP and oral lichenoid lesions (OLL) and investigate the possible risk factors for OLP malignant transformation into oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

We searched Medline, Scopus, and Web of Knowledge for relevant observational studies. Data on OLP malignant transformation were calculated as a pooled proportion (PP), using the Der-Simonian Liard method. We performed subgroup analyses by OLP diagnostic criteria, site, and clinical type, using Open Meta[Analyst] software. Data on possible risk factors for malignant transformation were pooled as odds ratios (ORs), using Comprehensive Meta-Analysis software.

RESULTS

Pooling data for OLP malignant transformation from 57 studies (19,676 patients) resulted in an overall PP of 1.1% [95% CI: 0.9%, 1.4%], while pooling data from 14 recent studies that used the World Health Organization-2003 diagnostic criteria resulted in an overall-PP of 0.9% [95% CI: 0.5%, 1.3%]. The risk of malignant transformation was higher (PP=2.5%, 95% CI [1%, 4%]) in OLL patients (419 patients). A significant increase of malignant transformation risk was noted among smokers (OR=2, 95% CI [1.25, 3.22]), alcoholics (OR=3.52, 95% CI [1.54, 8.03]), and HCV-infected patients (OR=5, 95% CI [1.56, 16.07]), compared to patients without these risk factors.

CONCLUSION

A small subset of OLP patients (1.1%) develop OSCC; therefore, regular follow-up for these patients is recommended. A higher incidence of malignant transformation was found among smokers, alcoholics, and HCV-infected patients; however, these associations should be further investigated.

Identification of the key genes implicated in the transformation of OLP to OSCC using RNA-sequencing

Oral lichen planus (OLP) is a chronic inflammatory disease that may transform to oral squamous cell carcinoma (OSCC), while its carcinogenesis mechanisms are not entirely clear. This study was designed to identify the important genes involved in the malignant transformation of OLP to OSCC. After RNA-sequencing, the differently expressed genes (DEGs) in OLP vs. normal and OSCC vs. normal groups, respectively, were identified by limma package in R language, and then clustering analysis were conducted by Pheatmap package in R language. Weighed gene co-expression network analysis (WGCNA) was performed for the DEGs to screen disease-associated modules. Using Cytoscape software, co-expression networks were constructed for the genes involved in the modules. Enrichment analysis was conducted for the genes involved in the co-expression networks using GOstat package in R language. Finally, quantitative real-time PCR (qRT-PCR) experiments were conducted to validate the key genes. There were, respectively, 223 and 548 DEGs in OLP vs. normal and OSCC vs. normal groups. WGCNA identified the blue modules for the DEGs in the two groups as disease-associated modules. Moreover, 19 common DEGs (including upregulated BCL9L, PER2 and TSPAN33, and downregulated GMPS and HES1) associated with both OLP and OSCC were identified. In the co-expression networks, BCL9L, HES1, PER2 and TSPAN33 might function in OLP via interactions (such as BCL9L-TSPAN33 and HES1-PER2). qRT-PCR analysis showed that BCL9L, PER2 and TSPAN33 were significantly upregulated, and GMP and HES1 were downregulated. These findings indicated that BCL9L, GMPS, HES1, PER2 and TSPAN33 affected the transformation of OLP to OSCC.

Analysis of human serum metabolome for potential biomarkers identification of erosive oral lichen planus

BACKGROUND

Oral lichen planus (OLP) is a chronic auto-inflammatory mucositis and potentially oral premalignant lesion. Erosive OLP patients display the higher canceration rate as compared to the patients with non-erosive OLP. Identification of the potential biomarkers associated with erosive OLP may help to investigate the disease pathogenesis and to improve clinical treatment.

METHODS

Ultra-performance liquid chromatography-quadrupole time-of-flight-mass spectrometry (UPLC-QTOF-MS) combined with pattern recognition approaches were integrated to acquire differentially expressed metabolites for the pathways analysis and elucidate mechanisms of disease.

RESULTS

Totally, 10 modulated metabolites were characterized as the potential biomarkers of erosive OLP, whose dysregulations could affect multiple metabolic pathways and pathological processes in the disease.

CONCLUSION

These findings indicated that the analysis of human serum metabolome might be conducive to the achievement of the objectives of this study.

Interleukin-1 beta transactivates epidermal growth factor receptor via the CXCL1-CXCR2 axis in oral cancer

Hyperactivation of the epidermal growth factor receptor (EGFR) pathways and chronic inflammation are common characteristics of oral squamous cell carcinoma (OSCC). Previously, we reported that OSCC cells secrete interleukin-1 beta (IL-1β), which promotes the proliferation of the oral premalignant cell line, DOK, and stimulates DOK and OSCC cells to produce the chemokine CXCL1. CXCL1 functions through CXCR2, a G protein-coupled receptor that transactivates EGFR in ovarian and lung cancers. We hypothesized that IL-1β transactivates EGFR through the CXCL1–CXCR2 axis in OSCC. In this study, we demonstrated that tyrosine phosphorylation of EGFR is crucial for the IL-1β-mediated proliferation and subsequent bromodeoxyuridine (BrdU) incorporation of DOK cells because the EGFR inhibitors AG1478 and erlotinib inhibit these abilities in a dose-dependent manner. Addition of IL-1β instantly enhanced CXCL1 expression and secretion (within 15 min) in the DOK and OSCC cell lines. Furthermore, tyrosine phosphorylation of EGFR was significantly enhanced in DOK (1 h) and OSCC (20 min) cell lines after IL-1β treatment, and both cell lines were inhibited on the addition of an IL-1 receptor antagonist (IL-1Ra). CXCL1 treatment resulted in EGFR phosphorylation, whereas the knockdown of CXCL1 expression by lentivirus-mediated shRNA or the addition of the CXCR2 antagonist SB225002 dramatically reduced IL-1β-mediated EGFR phosphorylation and proliferation of DOK cells. Neutralizing antibodies against IL-1β or CXCL1 markedly inhibited the constitutive or IL-1β-induced tyrosine phosphorylation of EGFR in OSCC cells. IL-1β transactivates EGFR through the CXCL1-CXCR2 axis, revealing a novel molecular network in OSCC that is associated with autocrine IL-1β and EGFR signaling.

Survivin expression in oral lichen planus: Role in malignant transformation

Context:

Oral lichen planus (OLP) is a potentially malignant disease with a prevalence rate of 0.5–2.2%. It is a T-cell-mediated autoimmune disease, in which cytotoxic CD8+ T-cells trigger apoptosis of the basal cells of oral epithelium. The reported progression of OLP to oral squamous cell carcinoma (OSCC) ranges from 0.4% to 6.5%. Apoptosis plays a major role in the maintenance of tissue homeostasis. The evasion of apoptosis in the form of dysregulation of inhibitors of apoptosis proteins (IAPs) may lead to malignant transformation. Survivin belongs to the second gene family of IAPs, which is overexpressed in many tumors such as OSCC and gastric carcinomas, and its expression is widely involved in apoptosis as well as in tumor metastasis.

Materials and Methods:

Sections were obtained from the paraffin-embedded archival blocks of patients diagnosed histologically as OLP, and cases with normal epithelium were used for comparison whereas cases with OSCC were used as positive control.

Results:

We analyzed the expression of survivin in OLP and normal epithelium. Survivin expression with moderate intensity was seen in the cells of basal layer with nuclear positivity in cases of OLP, whereas mild to nil expression was seen in normal epithelium with nuclear and cytoplasmic positivity in different layers.

Conclusions:

Survivin positivity was seen predominantly in the basal cells of OLP suggesting increased longevity of these cells which in turn might acquire dysplastic changes leading to increased risk of malignant transformation of this premalignant condition. Although the conversion rate may be low, the potential exists in the indolent course of the disease.

Oral lichen planus: a literature review and update

Lichen planus (LP) is a common chronic inflammatory condition that can affect skin and mucous membranes, including the oral mucosa. Because of the anatomic, physiologic and functional peculiarities of the oral cavity, the oral variant of LP (OLP) requires specific evaluations in terms of diagnosis and management. In this comprehensive review, we discuss the current developments in the understanding of the etiopathogenesis, clinical-pathologic presentation, and treatment of OLP, and provide follow-up recommendations informed by recent data on the malignant potential of the disease as well as health economics evaluations.