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Das A, Giri S. A Review on Role of Arecoline and Its Metabolites in the Molecular Pathogenesis of Oral Lesions with an Insight into Current Status of Its Metabolomics. Prague Med Rep 2020; 121:209-235. [PMID: 33270010 DOI: 10.14712/23362936.2020.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Areca nut consumption is a popular habit in Southeast Asian countries. One of the important biologically active alkaloids of areca nut is arecoline, which plays a role in mediating the development of several pathologies of the primary exposure site, the oral cavity. Studies on the metabolism of arecoline revealed the formation of several metabolites which themselves might be toxic. Moreover, polymorphisms in genes encoding enzymes involved in the metabolism of arecoline might predispose an organism towards the development of oral cancer. The present review tries to accumulate all the relevant existing literature and then elucidate the molecular mechanism by which arecoline plays a role in the development of oral submucous fibrosis and oral cancer. Existing information regarding arecoline metabolism, enzymes involved in the metabolic process and biological effects of the metabolites of arecoline have also been compiled and compared to study the toxicity of metabolites with its parent compound arecoline and whether they play any role in the pathogenesis of oral cancer mediated by areca nut consumption. A repertoire of molecular targets has come up in the discussion whose expression profile is perturbed by arecoline. Construction of induction cascade from existing literature has given an idea about the process of molecular pathogenesis. The summarized and analysed data can help to determine the molecular mechanism and drug targets, which in turn could be helpful in the prevention or treatment of these pathological conditions. It also brings into light areas where further research needs to be directed.
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Affiliation(s)
- Aparajita Das
- Laboratory of Molecular and Cell Biology, Department of Life Science and Bioinformatics, Assam University, Silchar, India
| | - Sarbani Giri
- Laboratory of Molecular and Cell Biology, Department of Life Science and Bioinformatics, Assam University, Silchar, India.
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Kim HJ, Ko JW, Cha SB, Heo HS, Seo JH, Cha MJ, Bae JS, Lee HK, Song SW, Kim JC. Evaluation of 13-week repeated oral dose toxicity of Areca catechu in F344/N rats. Food Chem Toxicol 2018; 114:41-51. [DOI: 10.1016/j.fct.2018.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/28/2022]
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3
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Chen PH, Mahmood Q, Mariottini GL, Chiang TA, Lee KW. Adverse Health Effects of Betel Quid and the Risk of Oral and Pharyngeal Cancers. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3904098. [PMID: 29376073 PMCID: PMC5742426 DOI: 10.1155/2017/3904098] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/01/2017] [Accepted: 05/18/2017] [Indexed: 02/06/2023]
Abstract
Global reports estimate 600 million betel quid (BQ) chewers. BQ chewing has been demonstrated not only to be a risk factor for cancers of the oral cavity and pharynx and oral potentially malignant disorders (OPMD) but also to cause other cancers and adverse health effects. Herein, we summarized the international comparison data to aid in the understanding of the close relationship between the prevalence of BQ chewing, the occurrence of oral and pharyngeal cancers, and adverse health effects. Potential biomarkers of BQ carcinogens, such as areca nut, alkaloids, and 3-methylnitrosaminopropionitrile (MNPN), are closely associated with human health toxicology. Molecular mechanisms or pathways involving autophagy, hypoxia, COX-2, NF-κB activity, and stemness are known to be induced by BQ ingredients and are very closely related to the carcinogenesis of cancers of oral and pharynx. BQ abuse-related monoamine oxidase (MAO) gene was associated with the occurrence and progress of oral and pharyngeal cancers. In summary, our review article provides important insights into the potential roles of environmental BQ (specific alkaloid biomarkers and nitrosamine products MNPN) and genetic factors (MAO) and offers a basis for studies aiming to reduce or eliminate BQ-related OPMD and oral/pharyngeal cancer incidences in the future.
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Affiliation(s)
- Ping-Ho Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, No. 70 Lienhai Road, Kaohsiung 80424, Taiwan
| | - Qaisar Mahmood
- Department of Environmental Sciences, COMSATS Institute of Information Technology, Abbottabad, Pakistan
| | - Gian Luigi Mariottini
- Department of Earth, Environment and Life Sciences (DISTAV), University of Genova, Viale Benedetto XV 5, 16132 Genova, Italy
| | - Tai-An Chiang
- College of Human Science and Technology, Chung Hwa University of Medical Technology, No. 89, Wenhwa 1st St., Rende Shiang, Tainan 71703, Taiwan
| | - Ka-Wo Lee
- Department of Otolaryngology, Kaohsiung Medical University Hospital, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
- Department of Otolaryngology, College of Medicine, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
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4
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Sendos LN, Mian IM, Shah NL. Betel Nut Chewing: An Unrecognized Cause of Milk Alkali Syndrome. AACE Clin Case Rep 2016. [DOI: 10.4158/ep13413.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jeng JE, Tsai MF, Tsai HR, Chuang LY, Lin ZY, Hsieh MY, Chen SC, Chuang WL, Wang LY, Yu ML, Dai CY, Tsai JF. Impact of chronic hepatitis B and hepatitis C on adverse hepatic fibrosis in hepatocellular carcinoma related to betel quid chewing. Asian Pac J Cancer Prev 2014; 15:637-642. [PMID: 24568470 DOI: 10.7314/apjcp.2014.15.2.637] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
The pathogenesis of hepatocellular carcinoma (HCC) related to habitual betel quid (BQ) chewing is unclear. Risk of HCCis increased with adverse hepatic fibrosis. This study aimed to assess the impact of chronic viral hepatitis on adverse hepatic fibrosis in HCC related to BQ chewing. This hospital-based case-control study enrolled 200 pairs of age- and gender-matched patients with HCC and unrelated healthy controls. Serologic hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (anti-HCV), α-fetoprotein (AFP), and surrogate markers for significant hepatic fibrosis were measured. Information on substance-use habits was obtained with a questionnaire. By analysis of surrogate markers for hepatic fibrosis, the prevalence of significant hepatic fibrosis in patients chewing BQ was between 45.8% and 91.7%, whereas that for patients without BQ chewing was between 18.4% and 57.9%. The difference was significant (P <0.05 for each surrogate marker). Multivariate analysis indicated that cirrhosis with Child-Pugh C (odds ratio (OR) = 3.28; 95% confidence interval (CI), 1.29- 8.37), thrombocytopenia (OR = 3.92, 95% CI, 1.77-8.68), AFP >400 mg/L (OR = 2.21, 95% CI, 1.05-4.66) and male gender (OR = 4.06, 95% CI, 1.29-12.77) were independent factors associated with habitual BQ chewing. In conclusion, adverse hepatic fibrosis and severe liver damage play important roles in the pathogenesis of BQ- related HCC, which could be aggravated by chronic hepatitis B and hepatitis C. BQ-cessation programs and prevention of chronic HBV/HCV infection are needed to prevent HCC related to BQ chewing.
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Affiliation(s)
- Jen-Eing Jeng
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan E-mail :
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6
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Yang MS, Lee CH, Chang SJ, Chung TC, Tsai EM, Ko AMJ, Ko YC. The effect of maternal betel quid exposure during pregnancy on adverse birth outcomes among aborigines in Taiwan. Drug Alcohol Depend 2008; 95:134-9. [PMID: 18282667 DOI: 10.1016/j.drugalcdep.2008.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 12/19/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
Abstract
In considering documented developmental toxicity and teratogenicity found in earlier research, maternal betel quid chewing may very well be linked to a higher risk of adverse birth outcomes. The aim of this study was to investigate the significance of betel quid chewing, together with the use of cigarettes or alcohol, either independently or combined, on birth-related outcomes. A total of 1264 aboriginal women who had just given birth in 10 hospitals in Southern and Eastern Taiwan were recruited. Information on their maternal and newborn characteristics was obtained from medical charts and by performing personal interviews using a validated questionnaire. Maternal areca nut chewing during pregnancy was found to be significantly associated with both birth weight loss (-89.54 g) and birth length reduction (-0.43 cm). A significantly lower male newborn rate (aOR=0.62) was observed among aboriginal women with a habit of betel quid chewing during pregnancy. The use of this substance conveyed a 2.40- and 3.67-fold independent risk of low birth weight and full-term low birth weight, respectively. An enhanced risk (aOR=3.26-5.99) of low birth weight was observed among women concomitantly using betel quid, cigarette and alcohol during gestation. Our findings suggest that betel quid chewing during pregnancy has a substantial effect on a number of birth outcomes, including sex ratio at birth, lower birth weight and reduced birth length.
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Affiliation(s)
- Mei-Sang Yang
- College of Nursing, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
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Miyazaki M, Sugawara E, Yoshimura T, Yamazaki H, Kamataki T. Mutagenic activation of betel quid-specific N-nitrosamines catalyzed by human cytochrome P450 coexpressed with NADPH-cytochrome P450 reductase in Salmonella typhimurium YG7108. Mutat Res 2005; 581:165-71. [PMID: 15725615 DOI: 10.1016/j.mrgentox.2004.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 12/07/2004] [Accepted: 12/07/2004] [Indexed: 11/23/2022]
Abstract
Betel quid chewing is known to cause cheek cancer in a wide area covering Africa to Asia. Areca nut contained in the betel quid is believed to give rise to carcinogenic N-nitrosamines. In the present study, the roles of human cytochromes P450 (P450 or CYP) in the mutagenic activation of betel quid-specific N-nitrosamines such as 3-(N-nitrosomethylamino)propionitrile (NMPN), 3-(N-nitrosomethylamino)propionaldehyde (NMPA) and N-nitrosoguvacoline (NG) were examined by using genetically engineered Salmonella typhimurium YG7108 expressing each form of human P450 together with NADPH-P450 reductase, which had been established in our laboratory. Among typical P450s (CYP1A1, CYP1A2, CYP1B1, CYP2A6, CYP2A13, CYP2D6 or CYP3A4) examined, CYP2A6 was the most efficient activator of NMPN, followed by CYP1A1 and CYP1B1. The mutagenic activation of NMPN by CYP2A6 was seen at the substrate concentrations of microM levels (approximately 100 microM). The activation of NMPA was catalyzed predominantly by CYP2A13 and to lesser extents by CYP2A6, CYP1A1, CYP1A2 and CYP1B1. The activation of NMPA by CYP2A13 was detectable at the substrate concentrations of microM levels (approximately 1 microM). NG was activated by CYP2A13 and CYP2A6, the genotoxicity of NG being much lower than that of NMPA or NMPN. Based on these data, we conclude that human CYP2A subfamily members play important roles in the mutagenic activation of essentially all betel quid-related N-nitrosamines tested in the present study.
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Affiliation(s)
- Masafumi Miyazaki
- Laboratory of Drug Metabolism, Graduate School of Pharmaceutical Sciences, Hokkaido University, N12W6, Kita-ku, Sapporo 060-0812, Japan
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8
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Chiang CP, Chang MC, Lee JJ, Chang JYF, Lee PH, Hahn LJ, Jeng JH. Hamsters chewing betel quid or areca nut directly show a decrease in body weight and survival rates with concomitant epithelial hyperplasia of cheek pouch. Oral Oncol 2004; 40:720-7. [PMID: 15172642 DOI: 10.1016/j.oraloncology.2003.12.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Accepted: 01/15/2004] [Indexed: 10/26/2022]
Abstract
Betel quid (BQ) chewing is strongly associated with the occurrence of oral leukoplakia, oral submucous fibrosis, and oral cancer. There are about 200-600 million BQ chewers in the world. Previous animal studies support the potential carcinogenicity of BQ in different test systems. However, little animal experiment has let hamsters or rats to chew BQ directly, similar to that in humans. In the present study, we established a hamster model of chewing BQ or areca nut (AN). A total of 81 2-week-old hamsters were randomly divided into three groups: 25 for control group, 28 for BQ-chewing group, and 28 for AN-chewing group. These animals were fed with powdered diet with/without BQ or AN for 18 months. Although the consumption of BQ or AN showed some variations, hamsters fed with powdered diet could chew and grind AN or BQ into small pieces of coarse fibers during the entire experimental period. The survival rate of AN-chewing hamsters decreased significantly after 6 months of exposure. The mean survival time was 15.6 +/- 0.9 months for control animals, 13.6 +/- 0.98 months for AN-chewing animals, and 15.7 +/- 0.55 months for BQ-chewing animals. The body weight of BQ- or AN-chewing animals also decreased after 4-13 months. Hamsters fed with AN for 18 months showed hyperkeratosis in 80% and acanthosis in 50% of cheek pouches. Animals fed with BQ for 18 months also showed hyperkeratosis in 93% and acanthosis in 14% of cheek pouches. These results indicate that AN and BQ components may induce alterations in proliferation and differentiation of oral epithelial cells. Animal model of chewing BQ or AN can be useful for future tumor initiation, promotion and chemoprevention experiments simulating the condition of BQ chewing in humans.
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Affiliation(s)
- Chun-Pin Chiang
- Laboratory of Dental Pharmacology and Toxicology, Department of Dentistry, Graduate Institute of Clinical Dental Science, College of Medicine, National Taiwan University Hospital and National Taiwan University, No. 1 Chang-Te Street, Taipei 100
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9
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Tsai JF, Jeng JE, Chuang LY, Ho MS, Ko YC, Lin ZY, Hsieh MY, Chen SC, Chuang WL, Wang LY, Yu ML, Dai CY. Habitual betel quid chewing and risk for hepatocellular carcinoma complicating cirrhosis. Medicine (Baltimore) 2004; 83:176-187. [PMID: 15118544 DOI: 10.1097/01.md.0000126971.80227.a4] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This case-control study aimed to assess the independent and interactive role of habitual betel quid chewing and known risk factors for hepatocellular carcinoma (HCC). Subjects enrolled included 210 pairs of sex- and age-matched cirrhotic patients with HCC, patients with cirrhosis alone, and healthy controls. Information on risk factors was obtained through serologic examination of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV), and a standardized personal interview with a structured questionnaire. Multivariate analysis indicated that betel quid chewing (odds ratio [OR], 5.81; 95% confidence interval [CI], 2.26-14.94); HBsAg (OR, 37.98; 95% CI, 19.65-73.42); and anti-HCV (OR, 47.23; 95% CI, 18.86-118.25) were independent risk factors for HCC when HCC patients were compared with healthy controls. Using patients with cirrhosis alone as a reference group, multivariate analysis indicated that only betel quid chewing (OR, 1.69; 95% CI, 1.04-2.76) and HBsAg (OR, 1.54; 95% CI, l.01-2.37) were independent risk factors for HCC. There was an additive interaction between betel quid chewing and the presence of either HBsAg (synergy index, 5.22) or anti-HCV (synergy index, 1.35). Moreover, a higher risk of HCC was associated with a longer duration of betel quid chewing and a larger amount of betel quid consumed (each p(for trend) < 0.0001). In conclusion, betel quid chewing is an independent risk factor for cirrhotic HCC. There is an additive interaction between betel quid chewing and chronic hepatitis B and/or hepatitis C virus infection.
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Affiliation(s)
- Jung-Fa Tsai
- From the Department of Internal Medicine, Clinical Laboratory, Biochemistry, and Public Health, Kaohsiung Medical University College of Medicine; the National Health Research Institutes, and the Institute of Biomedical Sciences, Academia Sinica, Taiwan
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10
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Abstract
Deleterious effects of areca nut on oral soft tissues are published extensively in the dental literature. Its effects on dental caries and periodontal tissues, two major oral diseases, are less well researched. Areca-induced lichenoid lesions mainly on buccal mucosa or tongue are reported at quid retained sites. In chronic chewers a condition known as betel chewer's mucosa, a discoloured areca nut-encrusted change, is often found where the quid particles are retained. Areca nut chewing is implicated in oral leukoplakia and submucous fibrosis, both of which are potentially malignant in the oral cavity. Oral cancer often arises from such precancerous changes in Asian populations. In 1985 the International Agency for Research on Cancer concluded that there is limited evidence to conclude that areca chewing may directly lead to oral cancer. There is, however, new information linking oral cancer to pan chewing without tobacco, suggesting a strong cancer risk associated with this habit. Public health measures to quit areca use are recommended to control disabling conditions such as submucous fibrosis and oral cancer among Asian populations.
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Affiliation(s)
- C R Trivedy
- Department of Oral Pathology and Medicine, WHO Collaborating Center for Oral Cancer and Precancer, The Guy's Medical and Dental School of King's College, London, UK
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11
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Yang MJ, Chung TC, Yang MJ, Hsu TY, Ko YC. Betel quid chewing and risk of adverse birth outcomes among aborigines in eastern Taiwan. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2001; 64:465-472. [PMID: 11732697 DOI: 10.1080/152873901753215920] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
It is known that substance abuse during pregnancy is associated with increased risk of adverse birth outcomes. The aim of this study was to determine the use of alcohol, cigarettes, betel quid, and drugs among pregnant aboriginal women and to assess the risk of adverse effects of betel quid use on birth outcomes in eastern Taiwan. Of a total of 229 women recruited into this study, 32 women with adverse birth outcomes constituted the case group. Analyses revealed that adverse birth outcomes were associated with maternal betel quid chewing and maternal age. After adjusting for maternal age, the risk of adverse birth outcome was five times higher among betel quid chewing women as compared to substance nonusers. Based on this finding, it is suggested health education, especially when concerned with the harmful effects of substance abuse, which includes betel quid use during pregnancy, should be stressed in concert with routine prenatal care.
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Affiliation(s)
- M J Yang
- School of Nursing, Kaohsiung Medical University, Taiwan
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12
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Jeng JH, Chang MC, Hahn LJ. Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives. Oral Oncol 2001; 37:477-92. [PMID: 11435174 DOI: 10.1016/s1368-8375(01)00003-3] [Citation(s) in RCA: 285] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Betel quid (BQ)-chewing is a popular oral habit with potential links to the occurrence of oral cancer. Many of the literature-based studies reveal that areca nut (AN) extract may demonstrate mutagenic and genotoxic effects, in addition to inducing preneoplastic as well as neoplastic lesions in experimental animals. Areca nut should, thus, be highly suspected as a human carcinogen. Toxicity studies relating to AN-contained polyphenols and tannins are not conclusive, with both carcinogenic and anti-carcinogenic effects being reported. The mutagenicity and genotoxicity of areca alkaloids has been detected by many short-term assays. However, their genotoxicity to oral fibroblasts and keratinocytes, the target cells of BQ, has not been identified. It would thus appear that AN toxicity is not completely due to its polyphenol, tannin and alkaloid content. The single agent which is responsible for AN carcinogenicity awaits further clarification. Reactive oxygen species produced during auto-oxidation of AN polyphenols in the BQ-chewer's saliva, are crucial in the initiation and promotion of oral cancer. Nitrosation of areca alkaloids also produces AN-specific nitrosamines, that have been demonstrated to be mutagenic, genotoxic and are capable of inducing tumors in experimental animals. Arecaidine and AN extract are further suggested to be tumor promoters. Antioxidants such as glutathione and N-acetyl-L-cysteine can potentially prevent such AN-elicited cytotoxicity. Further studies are needed to delineate the metabolism of AN ingredient and their roles in the multi-step chemical carcinogenesis, in order to enhance the success of the future chemoprevention of oral cancer and oral submucous fibrosis.
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Affiliation(s)
- J H Jeng
- Laboratory of Dental Pharmacology and Toxicology, College of Medicine, Graduate Institute of Clinical Dental Science, National Taiwan University, No. 1 Chang-Te Street, Taipei, Taiwan.
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Tsai JF, Chuang LY, Jeng JE, Ho MS, Hsieh MY, Lin ZY, Wang LY. Betel quid chewing as a risk factor for hepatocellular carcinoma: a case-control study. Br J Cancer 2001; 84:709-13. [PMID: 11237396 PMCID: PMC2363779 DOI: 10.1054/bjoc.1999.1597] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The role of betel quid chewing in the aetiology of hepatocellular carcinoma (HCC) was evaluated in a case-control study including 263 pairs of age- and sex-matched HCC patients and healthy controls. Serum hepatitis B surface antigen (HBsAg), and antibodies to hepatitis C virus (anti-HCV) were determined, and standardized personal interview conducted using a structured questionnaire. Multivariate analysis indicated that betel quid chewing (odds ratio (OR), 3.49; 95% confidence interval (CI), 1.74-6.96), HBsAg (OR, 16.69; 95% CI, 9.92-28.07), anti-HCV (OR, 38.57; 95% CI, 18.15-81.96), and educational duration of less than 10 years (OR, 1.71; 95% CI, 1.05-2.78) are independent risk factors of HCC. In addition, there was an additive interaction between betel quid chewing and chronic infection with either hepatitis B virus (synergy index, 5.37) or hepatitis C virus (synergy index, 1.66). Moreover, risk on HCC increased as duration of betel quid chewing increased, or amount of betel quid consumed (each P for trend < 0.0001).
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Affiliation(s)
- J F Tsai
- Department of Internal Medicine, Kaohsiung Medical University College of Medicine, Taiwan, Republic of China
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Mannan N, Boucher BJ, Evans SJ. Increased waist size and weight in relation to consumption of Areca catechu (betel-nut); a risk factor for increased glycaemia in Asians in east London. Br J Nutr 2000; 83:267-75. [PMID: 10884715 DOI: 10.1017/s0007114500000349] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Type 2 diabetes is commoner in Asians than Caucasians. Many nitrosamines are diabetogenic, causing both type 2 and type 1 diabetes. Of CD1 mice fed with betel-nut or associated nitrosamines 8.5% develop glucose intolerance with marked obesity. Glycaemia and anthropometric risk markers for type 2 diabetes were therefore examined in relation to betel usage in 993 'healthy' Bangladeshis by one bilingual research-worker (N.M.). Of these, 12% had known diabetes. A further 145 of 187 subjects 'at-risk' of diabetes (spot glucose > 6.5 mmol/l < 2 h after food, or > 4.5 mmol/l > 2 h after food) had a second blood glucose sample taken; sixty-one were confirmed as 'at-risk', and had an oral glucose tolerance test; nine new diabetics were identified. Multiple regression analysis showed that spot blood glucose values decreased with time after eating (P = 0.0005) and increased independently with waist size (P = 0.0005) and age (P = 0.0005) without relationships to other aspects of the diet, season or smoking. Waist size was strongly related to betel usage independent of other factors such as age. Betel use interacted with sex, relating to increasing glycaemia only in females. Since waist and age were the major markers of increasing glycaemia we suggest that betel chewing, a habit common to about 10% of the world population (more than 200 million people) may contribute to the risk of developing type 2 diabetes mellitus.
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Affiliation(s)
- N Mannan
- Academic Medical Unit, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary Westfield College, UK
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15
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Saroja M, Balasenthil S, Nagini S. Tissue lipid peroxidation and glutathione-dependent enzyme status in patients with oral squamous cell carcinoma. Cell Biochem Funct 1999; 17:213-6. [PMID: 10451543 DOI: 10.1002/(sici)1099-0844(199909)17:3<213::aid-cbf831>3.0.co;2-b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We examined the extent of lipid peroxidation and the status of reduced glutathione (GSH) and the GSH-dependent enzymes-glutathione peroxidase (GPx) and glutathione-S-transferase (GST)-in oral tumour tissues from 33 adult oral cancer patients and an equal number of age- and sex-matched normal subjects. Diminished lipid peroxidation in the oral tumour tissue was accompanied by a significant decrease in phospholipids and an increase in the cholesterol/phospholipid (C/P) ratio. The concentration of glutathione and the activities of GPx and GST were elevated in oral tumour tissues. These findings suggest that GSH- and GSH-dependent enzymes play a crucial role in tobacco-related tumourigenesis and may be considered as markers of carcinogen exposure.
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Affiliation(s)
- M Saroja
- Department of Biochemistry, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
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16
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Abstract
OBJECTIVES To investigate trends in mortality rates of oral cancer patients in Japan between 1950 and 1993 by sex, age and cancer site, and compare the results with previous studies to determine whether there are any common characteristics of oral cancer patterns between Japan and European countries. MATERIAL AND METHODS The mortality data obtained from the Japanese Vital Statistics were analyzed using the 5-year moving average method, and the mortality rates were adjusted to the 1990 world population by age and sex. Age-specific mortality rates were analyzed by birth cohort. RESULTS The age-standardized mortality rates among the males increased from 1.14 per 100,000 person--years in 1952 to 1.84 in 1991, whereas the corresponding rate among females changed little over the same period. Cancer of the tongue was the most common cause of death in Japan among the five studied oral regions: lip, tongue, floor of the mouth, major salivary glands and oropharynx, males aged under 54 born in 1920 or later were found to have an increased risk of such disease. CONCLUSION Further epidemiological investigations are necessary to clarify the etiology of oral cancer in Japan.
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Affiliation(s)
- Y Zheng
- Department of Public Health, Nara Medical University, Japan.
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Grafström RC, Norén UG, Zheng X, Elfwing A, Sundqvist K. Growth and transformation of human oral epithelium in vitro. Recent Results Cancer Res 1997; 143:275-306. [PMID: 8912427 DOI: 10.1007/978-3-642-60393-8_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R C Grafström
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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18
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Jin YT, Tsai ST, Wong TY, Chen FF, Chen RM. Studies on promoting activity of Taiwan betel quid ingredients in hamster buccal pouch carcinogenesis. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1996; 32B:343-6. [PMID: 8944839 DOI: 10.1016/0964-1955(96)00018-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Previous studies indicated that Taiwan betel quid is a promoter rather than an initiator during the carcinogenesis of hamster buccal pouch carcinoma. The maximum promoting activity can be demonstrated 24 weeks after betel quid implantation, following an initial application of 0.5% DMBA (7,12-dimethyl benzanthracene) three times per week for 4 weeks. In the present study, components of Taiwan betel quid and its additives (dry betel nut fibre, piper betel, slaked lime, cold aqueous extract, and hot aqueous extract) were applied respectively or in various combinations to investigate their promoting activity. One hundred and thirty Syrian hamsters were divided into 13 groups based on different combinations of the betel quid ingredients applied. The incidence of tumours in the hamster buccal pouch was significantly higher in groups exposed to dry betel nut fibre (P < 0.01) and cold aqueous extract (P < 0.05). The results indicate that betel nut fibre and cold aqueous extract are the major components of betel quid that may promote carcinogenesis in the hamster buccal pouch.
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Affiliation(s)
- Y T Jin
- Department of Pathology, National Cheng Kung University Medical Center, Tainan, Taiwan
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19
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Abstract
In Taiwan, betel quid is a natural masticatory, which is composed of fresh green areca fruit, Piper betle and slaked lime paste. Areca fruit contains some alkaloids, of which arecoline is the major one. N-Nitrosoguvacoline (NG), one of the N-nitrosation products of arecoline, is the only one N-nitrosamine found in Taiwanese betel quid chewing saliva. The mutagenic studies in Ames Salmonella microsome test showed that crude alkaloid extracts of areca fruit and arecoline were active in Salmonella typhimurium TA100, and NG was weakly active in TA98 and TA100. The activities in both arecoline and NG decreased further in the presence of rat liver S9 mix. Nitrite was significantly consumed during the N-nitrosation of arecoline and sodium nitrite at acidic condition (pH 3), whereas the formation of NG was favored at neutral condition (pH 7). Crude phenolic extracts of leaf and inflorescence of Piper betle inhibited the formation of NG by blocking the nitrite. However, a high amount of crude phenolic extracts of areca fruit enhanced the formation of NG.
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Affiliation(s)
- C K Wang
- Graduate Institute of Nutritional Science, Chung Shan Medical and Dental College, Taichung, Taiwan, ROC.
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20
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Paterson IC, Eveson JW, Prime SS. Molecular changes in oral cancer may reflect aetiology and ethnic origin. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1996; 32B:150-3. [PMID: 8762870 DOI: 10.1016/0964-1955(95)00065-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Oral cancer, although uncommon in the Western world, accounts for up to 40% of all malignancies in parts of India and South East Asia. Recognised aetiological agents of oral cancer include tobacco and alcohol. This paper reviews the spectrum of molecular changes found in oral squamous cell carcinomas from Western (U.K., U.S.A., Australia) and Eastern (India, S.E. Asia) countries. p53 mutations are common in tumours from the West (47%) but are infrequent in the East (7%). Tumours from India and South East Asia are characterised by the involvement of ras oncogenes, including mutation, loss of heterozygosity (H-ras) and amplification (K- and N-ras), events which are uncommon in the West. The possibility that these genetic differences reflect aetiology and/or ethnic origin is discussed.
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Affiliation(s)
- I C Paterson
- Division of Oral Medicine, Pathology and Microbiology, Department of Oral and Dental Science, Bristol, U.K
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21
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Hoffmann D, Brunnemann KD, Prokopczyk B, Djordjevic MV. Tobacco-specific N-nitrosamines and Areca-derived N-nitrosamines: chemistry, biochemistry, carcinogenicity, and relevance to humans. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH 1994; 41:1-52. [PMID: 8277523 DOI: 10.1080/15287399409531825] [Citation(s) in RCA: 211] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Nicotine and the minor tobacco alkaloids give rise to tobacco-specific N-nitrosamines (TSNA) during tobacco processing and during smoking. Chemical-analytical studies led to the identification of seven TSNA in smokeless tobacco (< or = 25 micrograms/g) and in mainstream smoke of cigarettes (1.3 micrograms TSNA/cigarette). Indoor air polluted by tobacco smoke may contain up to 24 pg/L of TSNA. In mice, rats, and hamsters, three TSNA, N'-nitrosonornicotine (NNN), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), are powerful carcinogens; two TSNA are moderately active as carcinogens; and two TSNA appear not to be carcinogenic. The TSNA are procarcinogens, agents that require metabolic activation. The active forms of the carcinogenic TSNA react with cellular components, including DNA, and with hemoglobin (Hb). The Hb adducts in chewers and smokers serve as biomarkers for the uptake and metabolic activation of carcinogenic TSNA and the urinary excretion of NNAL as free alcohol and as glucuronide for the uptake of TSNA. The review presents evidence that strongly supports the concept that TSNA contribute to the increased risk for cancer of the upper digestive tract in tobacco chewers and for the increased risk of lung cancer, especially pulmonary adenocarcinoma, in smokers. The high incidence of cancer of the upper digestive tract especially among men on the Indian subcontinent has been causally associated with chewing of betel quid mixed with tobacco. In addition to the TSNA, the betel quid chewers are exposed to four N-nitrosamines that are formed during chewing from the Areca alkaloids, two of these N-nitrosamines are carcinogens. The article also reviews approaches toward the reduction of the carcinogenic potency of smokeless tobacco, betel quid-tobacco mixtures, and cigarette smoke. Although the safest way to reduce the risk for tobacco-related cancers is to refrain from chewing and smoking, modifications of smokeless tobacco and of cigarettes are indicated to lead to less toxic products. Another more recent approach for reducing the carcinogenic effect of tobacco products is the application of chemopreventive agents, primarily of micronutrients. Future aspects in tobacco carcinogenesis, especially as it relates to TSNA, are expected in the field of molecular biochemistry and in biomarker studies, with the goal of identifying those tobacco and betel quid chewers and tobacco smokers who are at especially high risk for cancer.
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Affiliation(s)
- D Hoffmann
- American Health Foundation, Valhalla, New York 10595
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22
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Sundqvist K, Grafström RC. Effects of areca nut on growth, differentiation and formation of DNA damage in cultured human buccal epithelial cells. Int J Cancer 1992; 52:305-10. [PMID: 1521917 DOI: 10.1002/ijc.2910520225] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Because the high incidence of oral cancers in South-East Asia is causally linked to the common habit of betel quid chewing, the effects of an aqueous extract of areca nut, one of the main ingredients of the quid, on growth, differentiation, morphology and DNA damage were studied in cultured human buccal epithelial cells. An acute exposure (3 hr) of the cells to the extract altered their morphology and induced ridges in the plasma membrane, with indications of internalization of extract particles. Such exposure also caused formation of DNA single-strand breaks which accumulated during post-treatment culture, indicating continuous exposure to residual particles and/or the possibility of inhibited DNA repair. The extract accelerated terminal differentiation of the cells, measured as involucrin expression at relatively non-toxic levels. The extract caused similar loss of colony-forming efficiency in normal cells and in a buccal carcinoma cell line (SqCC/YI) which was defective in its ability to undergo differentiation, indicating that extract toxicity could occur independently from this response. Finally, the genotoxicity of the salivary areca-nut-specific carcinogen 3-(N-nitrosomethyl-amino)propionaldehyde, was demonstrated by the formation of DNA protein cross-links and DNA single-strand breaks in normal buccal epithelial cells. These findings in vitro suggest that betel quid carcinogenesis in the human oral cavity may involve cytopathic alterations of normal cell morphology, growth and differentiation, as well as formation of DNA damage by areca-nut-related agents extracted or formed in saliva.
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Affiliation(s)
- K Sundqvist
- Department of Toxicology, Karolinska Institute, Stockholm, Sweden
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