Enhanced penetration of nitrosonornicotine across oral mucosa in the presence of ethanol

The Combined Effects of Alcohol Consumption and Smoking on Cancer Risk by Exposure Level: A Systematic Review and Meta-Analysis

BACKGROUND

Alcohol consumption is a major risk factor for cancer, and when combined with smoking, the risk increases. Nevertheless, few studies have comprehensively evaluated the combined effects of alcohol consumption and smoking on the risk of various cancer types. Therefore, to assess these effects, we conducted a systematic review and meta-analysis.

METHODS

We performed a systematic search of five literature databases, focusing on cohort and case-control studies. Considering exposure levels, we quantified the combined effects of alcohol consumption and smoking on cancer risk and assessed multiplicative interaction effects.

RESULTS

Of 4,452 studies identified, 24 (4 cohort studies and 20 case-control studies) were included in the meta-analysis. We detected interaction effect of light alcohol and moderate smoking on head and neck cancer risk (relative risk [RR], 4.26; 95% confidence interval [CI], 2.50-7.26; I² = 65%). A synergistic interaction was observed in heavy alcohol and heavy smoking group (RR, 35.24; 95% CI, 23.17-53.58; I² = 69%). In more detailed cancer types, the interaction effect of heavy alcohol and heavy smoking was noticeable on oral (RR, 36.42; 95% CI, 24.62-53.87; I² = 46%) and laryngeal (RR, 38.75; 95% CI, 19.25-78.01; I² = 69%) cancer risk.

CONCLUSION

Our study provided a comprehensive summary of the combined effects of alcohol consumption and smoking on cancers. As their consumption increased, the synergy effect became more pronounced, and the synergy effect was evident especially for head and neck cancer. These findings provide additional evidence for the combined effect of alcohol and smoking in alcohol guidelines for cancer prevention.

Biopolymer Drug Delivery Systems for Oromucosal Application: Recent Trends in Pharmaceutical R&D

Oromucosal drug delivery, both local and transmucosal (buccal), is an effective alternative to traditional oral and parenteral dosage forms because it increases drug bioavailability and reduces systemic drug toxicity. The oral mucosa has a good blood supply, which ensures that drug molecules enter the systemic circulation directly, avoiding drug metabolism during the first passage through the liver. At the same time, the mucosa has a number of barriers, including mucus, epithelium, enzymes, and immunocompetent cells, that are designed to prevent the entry of foreign substances into the body, which also complicates the absorption of drugs. The development of oromucosal drug delivery systems based on mucoadhesive biopolymers and their derivatives (especially thiolated and catecholated derivatives) is a promising strategy for the pharmaceutical development of safe and effective dosage forms. Solid, semi-solid and liquid pharmaceutical formulations based on biopolymers have several advantageous properties, such as prolonged residence time on the mucosa due to high mucoadhesion, unidirectional and modified drug release capabilities, and enhanced drug permeability. Biopolymers are non-toxic, biocompatible, biodegradable and may possess intrinsic bioactivity. A rational approach to the design of oromucosal delivery systems requires an understanding of both the anatomy/physiology of the oral mucosa and the physicochemical and biopharmaceutical properties of the drug molecule/biopolymer, as presented in this review. This review summarizes the advances in the pharmaceutical development of mucoadhesive oromucosal dosage forms (e.g., patches, buccal tablets, and hydrogel systems), including nanotechnology-based biopolymer nanoparticle delivery systems (e.g., solid lipid particles, liposomes, biopolymer polyelectrolyte particles, hybrid nanoparticles, etc.).

In vitro permeation of nicotine and tobacco specific nitrosamines from smokeless tobacco product extracts in a 3D buccal tissue model

Tobacco product use is a risk factor in the development of oral cancer, although epidemiology studies show this risk is far less with smokeless tobacco product use than cigarette smoking. While smokeless tobacco contains harmful and potentially harmful constituents (HPHCs), the oral permeation of HPHCs in oral tobacco products is not completely understood. To improve the understanding, three different extract concentrations of the CORESTA reference products (CRP) for snus (CRP1.1) and moist snuff (CRP2.1) were applied to cellular tissue derived from two donors of EpiOral™ model, a 3D human buccal model, and permeation of nicotine and tobacco-specific nitrosamines (TSNAs) were measured over two hours. Permeation of 0.15% caffeine in complete artificial saliva and cell viability were also measured. Results showed that a consistent and concentration dependent cumulative permeation of nicotine and TSNAs was observed with high percent recovery in all conditions. A high degree of sensitivity was seen for all analytes, with minimal cytotoxicity for both CRPs. The data presented here show the EpiOral™ model is fit-for-purpose to evaluate the permeation of nicotine and TSNAs in nicotine-containing snus and moist snuff oral tobacco.

Alcohol and Cancer: Existing Knowledge and Evidence Gaps across the Cancer Continuum

Alcoholic beverages are carcinogenic to humans. Globally, an estimated 4.1% of new cancer cases in 2020 were attributable to alcoholic beverages. However, the full cancer burden due to alcohol is uncertain because for many cancer (sub)types, associations remain inconclusive. Additionally, associations of consumption with therapeutic response, disease progression, and long-term cancer outcomes are not fully understood, public awareness of the alcohol-cancer link is low, and the interrelationships of alcohol control regulations and cancer risk are unclear. In December 2020, the U.S. NCI convened a workshop and public webinar that brought together a panel of scientific experts to review what is known about and identify knowledge gaps regarding alcohol and cancer. Examples of gaps identified include: (i) associations of alcohol consumption patterns across the life course with cancer risk; (ii) alcohol's systemic carcinogenic effects; (iii) alcohol's influence on treatment efficacy, patient-reported outcomes, and long-term prognosis; (iv) communication strategies to increase awareness of the alcohol-cancer link; and (v) the impact of alcohol control policies to reduce consumption on cancer incidence and mortality. Interdisciplinary research and implementation efforts are needed to increase relevant knowledge, and to develop effective interventions focused on improving awareness, and reducing harmful consumption to decrease the alcohol-related cancer burden.

Enniatin-containing solutions for oromucosal use: Quality-by-design ex-vivo transmucosal risk assessment of composition variability

Fusafungine, a mixture of the cyclic hexadepsipeptides enniatins, is currently on the market for the treatment of upper respiratory tract diseases because of its bacteriostatic and anti-inflammatory effects. In this study, a quality-by-design risk assessment was performed with two objectives: (i) investigate whether enniatins are able to permeate the mucosa and reach blood circulation, as the summary of product characteristics indicates this is not the case, and if so, to quantify their transmucosal kinetics and (ii) study the influence of excipient concentration variability on mucosal permeation. First, the concentration of the two main excipients isopropyl myristate and ethanol, known penetration enhancers, in several marketed samples was determined using GC-FID. Then, the transmucosal kinetics of the enniatins were quantitatively evaluated for different dose solutions, using porcine buccal mucosa in an ex-vivo in-vitro Franz diffusion cell set-up, with UHPLC-MS/MS bioanalytics. This study demonstrated that enniatins are capable of permeating the mucosa. However, no risk of a significant different transmucosal permeability with varying excipient concentrations was detected.

Caffeic acid reduces the viability and migration rate of oral carcinoma cells (SCC-25) exposed to low concentrations of ethanol

Alcohol increases the risk of carcinoma originated from oral epithelium, but the biological effects of ultra-low doses of ethanol on existing carcinoma cells in combination with natural substances are still unclear. A role for ethanol (EtOH), taken in small amounts as an ingredient of some beverages or mouthwashes to change the growth behavior of established squamous cell carcinoma, has still not been examined sufficiently. We designed an in vitro study to determine the effect of caffeic acid (CFA) on viability and migration ability of malignant oral epithelial keratinocytes, exposed to ultra-low concentrations (maximum 100 mmol/L) EtOH. MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-dimethyltetrazolium bromide) and LDH (lactate dehydrogenase) assays were used to assess the cytotoxic effect of EtOH/CFA and the viability of squamous carcinoma SCC-25 cells (ATCC CRL-1628, mobile part of the tongue). Tested EtOH concentrations were: 2.5, 5, 10, 25, 50, and 100 mmol/L, along with an equal CFA concentration of 50 μmol/L. Carcinoma cells’ migration was investigated by monolayer “wound” healing assay. We demonstrated that very low concentrations of EtOH ranging between 2.5 and 10 mmol/L may induce the viability of oral squamous cell carcinoma cells, while the results following addition of CFA reveal an antagonistic effect, attenuating pro-proliferative EtOH activity. The migration rate of oral squamous carcinoma cells can be significantly inhibited by the biological activity of caffeic acid.

Ethanol impairs intestinal barrier function in humans through mitogen activated protein kinase signaling: a combined in vivo and in vitro approach

BACKGROUND

Ethanol-induced gut barrier disruption is associated with several gastrointestinal and liver disorders.

AIM

Since human data on effects of moderate ethanol consumption on intestinal barrier integrity and involved mechanisms are limited, the objectives of this study were to investigate effects of a single moderate ethanol dose on small and large intestinal permeability and to explore the role of mitogen activated protein kinase (MAPK) pathway as a primary signaling mechanism.

METHODS

Intestinal permeability was assessed in 12 healthy volunteers after intraduodenal administration of either placebo or 20 g ethanol in a randomised cross-over trial. Localization of the tight junction (TJ) and gene expression, phosphorylation of the MAPK isoforms p38, ERK and JNK as indicative of activation were analyzed in duodenal biopsies. The role of MAPK was further examined in vitro using Caco-2 monolayers.

RESULTS

Ethanol increased small and large intestinal permeability, paralleled by redistribution of ZO-1 and occludin, down-regulation of ZO-1 and up-regulation of myosin light chain kinase (MLCK) mRNA expression, and increased MAPK isoforms phosphorylation. In Caco-2 monolayers, ethanol increased permeability, induced redistribution of the junctional proteins and F-actin, and MAPK and MLCK activation, as indicated by phosphorylation of MAPK isoforms and myosin light chain (MLC), respectively, which could be reversed by pretreatment with either MAPK inhibitors or the anti-oxidant L-cysteine.

CONCLUSIONS

Administration of moderate ethanol dosage can increase both small and colon permeability. Furthermore, the data indicate a pivotal role for MAPK and its crosstalk with MLCK in ethanol-induced intestinal barrier disruption.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00928733.

Cytotoxicity and metabolic stress induced by acetaldehyde in human intestinal LS174T goblet-like cells

There is compelling evidence indicating that ethanol and its oxidative metabolite acetaldehyde can disrupt intestinal barrier function. Apart from the tight junctions, mucins secreted by goblet cells provide an effective barrier. Ethanol has been shown to induce goblet cell injury associated with alterations in mucin glycosylation. However, effects of its most injurious metabolite acetaldehyde remain largely unknown. This study aimed to assess short-term effects of acetaldehyde (0, 25, 50, 75, 100 μM) on functional characteristics of intestinal goblet-like cells (LS174T). Oxidative stress, mitochondrial function, ATP, and intramitochondrial calcium (Ca(2+)) were assessed by dichlorofluorescein, methyltetrazolium, and bioluminescence, MitoTracker green and rhod-2 double-labeling. Membrane integrity and apoptosis were evaluated by measuring lactate dehydrogenase (LDH), caspase 3/7, and cleavage of cytokeratin 18 (CK18). Expression of mucin 2 (MUC2) was determined by cell-based ELISA. Acetaldehyde significantly increased reactive oxygen species generation and decreased mitochondrial function compared with negative controls (P < 0.05). In addition, acetaldehyde dose-dependently decreased ATP levels and induced intramitochondrial Ca(2+) accumulation compared with negative controls (P < 0.05). Furthermore, acetaldehyde induced LDH release and increased caspase3/7 activity and percentage of cells expressing cleaved CK18 and increased MUC2 protein expression compared with negative controls (P < 0.0001). ATP depletion and LDH release could be largely prevented by the antioxidant N-acetylcysteine, suggesting a pivotal role for oxidative stress. Our data demonstrate that acetaldehyde has distinct oxidant-dependent metabolic and cytotoxic effects on LS174T cells that can lead to induction of cellular apoptosis. These effects may contribute to acetaldehyde-induced intestinal barrier dysfunction and subsequently to liver injury.

Demography and histologic pattern of laryngeal squamous cell carcinoma in kenya

Background. Laryngeal squamous cell carcinoma is a common head and neck cancer worldwide. Objective. To determine the demographic characteristics of patients with laryngeal cancer, establish their tumor characteristics and relate it to their smoking and alcohol ingestion habits. Methods. Fifty cases and fifty controls were recruited of matching age, sex, and region of residence. History and pattern of cigarette smoking and alcohol ingestion was taken and analyzed. Results. 33 (66%) of the cases and 3 (6%) among controls were current cigarette smokers. 74% had smoked for more than 30 years, P < 0.0001 OR 21.3 (95% CI: 2.6-176.1). There was a male predominance (96%) and most cases (62%) were from the ethnic communities in the highland areas of Kenya predominantly in Central and Eastern provinces. Very heavy drinkers had increased risk of P < 0.0001 OR, 6.0 (95% CI: 1.957-18.398) and those who smoked cigarettes and drank alcohol had poorly differentiated tumors G3, P < 0.001, OR 11.652 (95% CI 2.305-58.895), and G4, P=0.52 OR 7.286 (95% CI 0.726-73.075). They also presented with advanced disease (73.6%). Conclusion. Cigarette smoking and alcohol ingestion are strong risk factors for development of late stage and poorly differentiated laryngeal squamous cell carcinoma in Kenya.

Ethanol metabolism and its effects on the intestinal epithelial barrier

Ethanol is widely consumed and is associated with an increasing global health burden. Several reviews have addressed the effects of ethanol and its oxidative metabolite, acetaldehyde, on the gastrointestinal (GI) tract, focusing on carcinogenic effects or alcoholic liver disease. However, both the oxidative and the nonoxidative metabolites of ethanol can affect the epithelial barrier of the small and large intestines, thereby contributing to GI and liver diseases. This review outlines the possible mechanisms of ethanol metabolism as well as the effects of ethanol and its metabolites on the intestinal barrier. Limited studies in humans and supporting in vitro data have indicated that ethanol as well as mainly acetaldehyde can increase small intestinal permeability. Limited evidence also points to increased colon permeability following exposure to ethanol or acetaldehyde. In vitro studies have provided several mechanisms for disruption of the epithelial barrier, including activation of different cell-signaling pathways, oxidative stress, and remodeling of the cytoskeleton. Modulation via intestinal microbiota, however, should also be considered. In conclusion, ethanol and its metabolites may act additively or even synergistically in vivo. Therefore, in vivo studies investigating the effects of ethanol and its byproducts on permeability of the small and large intestines are warranted.

Helping individuals to understand synergistic risks: an assessment of message contents depicting mechanistic and probabilistic concepts

Accumulating evidence shows that certain hazard combinations interact to present synergistic risks. However, little is known about the most effective ways of helping individuals to understand this complex risk concept. More specifically, there is an absence of empirical research that has assessed the relative efficacy of messages that explain either the causal mechanism and/or the probabilistic components of synergistic risks. In an experiment designed to address this issue, we presented participants with messages concerning the synergistic risk of developing esophageal cancer for individuals who consume both tobacco and alcohol. Relative to a control group, we compared the extent to which messages featuring content detailing the underlying biological mechanism, the probabilistic risk, or both improved understanding of the synergistic risk. Our results showed that messages containing details of both the mechanism and probabilistic information were most effective at enabling individuals to understand that the alcohol-tobacco combination presents a synergistic risk. In addition, large improvements in the accuracy of cancer frequency estimates were observed amongst individuals who received probabilistic information, and the highest relative increase in professed willingness to adopt precautionary behaviors was observed amongst individuals who received the mechanism information only. Importantly, these findings could be utilized in the development of a general model for the communication of synergistic risks. Furthermore, in contrast to previous findings, our study demonstrates that risk messages can be both effective and efficient in helping individuals to acquire a greater understanding of synergistic risks. Acquiring such knowledge could lead to significant improvements in risk-related decisions concerning combined hazards.

Periodontal disease and mouthwash use are risk factors for head and neck squamous cell carcinoma

PURPOSE

The purpose of this study was to examine associations between oral hygiene, including history of periodontal disease and mouthwash use, and risk of head and neck squamous cell carcinoma (HNSCC).

METHODS

We measured history of oral hygiene and dental care on 513 HNSCC cases and 567 controls from a population-based study of HNSCC. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI).

RESULTS

Periodontal disease was associated with a slightly elevated risk of HNSCC (OR = 1.09, 95% CI: 1.02, 1.16). Using any type of mouthwash at least once per day was associated with increased risk compared to never using mouthwash (OR = 1.11, 95% CI: 1.02, 1.20). HNSCC was associated with frequent use of non-alcoholic mouthwash compared to using any kind of mouthwash rarely or never (OR = 1.24, 95% CI: 1.05, 1.47).

CONCLUSIONS

Our results support an association between periodontal disease and HNSCC. Our data suggest that mouthwash use is associated with HNSCC, but we noted no difference between the effects of alcohol-containing and non-alcoholic mouthwashes.

Exploring the mechanisms of alcohol-related damage in oral mucosa - is oxidative stress associated with the increase in cell proliferation in rat tongue epithelium?

CONTEXT

Alcohol consumption has been related to a cell proliferation increase in oral epithelium but its mechanism remains unclear.

OBJECTIVE

The aim of this study was to investigate whether oxidative stress parameters are implicated in the induction of cell proliferation in rat tongue epithelium after different times of chronic alcohol consumption.

MATERIALS AND METHODS

Cell proliferation was assessed in tongue epithelium using AgNOR (argyrophilic proteins related to active nucleolar organizer regions) quantification. Oxidative stress parameters [lipid peroxidation, protein carbonyls, superoxide dismutase activity and catalase (CAT) activity and immunocontent] and Nrf2 immunocontent were quantified in tongue homogenates.

RESULTS AND DISCUSSION

Mean AgNOR numbers (mAgNOR) per nucleus was 2.22 ± 0.30 in ventral tongue epithelium after 120 days of alcohol consumption (vs. 1.87 ± 0.18 for control animals and 1.91 ± 0.23 for animals treated with alcohol for 60 days) indicating cell proliferation increase (p < 0.05, ANOVA followed by Tukey post hoc). Interestingly, 60 days of alcohol consumption induced changes in oxidative stress parameters, but no alteration in cell proliferation. Vitamin E co-treatment was conduced in order to evaluate its possible protective effects. The 120 day Tween + vitamin E + alcohol treatment induced an increase in mAgNORs when compared to the Tween + vitamin E treated group (respectively 2.10 ± 0.30 vs. 1.77 ± 0.11, p < 0.05, ANOVA followed by Tukey post hoc), showing that vitamin E co-treatment had no protective effects. In addition, an inverse association was observed between CAT activity and AgNORs quantity (R = -0.32; p < 0.05, Person's correlation) as well as the possible involvement of Nrf2 in alcohol-related damage.

CONCLUSIONS

Our findings suggest that the increase in cell proliferation associated with alcohol-related damage has no direct relation with an imbalance in oxidative parameters. In contrast, our results indicate that hydrogen peroxide may be implicated in cellular signaling during proliferation in the oral mucosa.

Effectiveness and safety of a mouthwash containing essential oil ingredients

The mouthwash, Listerine®, was compounded in 1879 from four essential oils. Later, the oils were replaced by one ingredient per oil with approximately 25% ethanol as a vehicle to keep them in solution. From then on, Listerine® was no longer a medicinal plant product. In 2003, a review by the FDA Subcommittee on Oral Health Care Drug Products for Over-the-Counter Human Use concluded that the product is effective and safe, and a review of studies published in the meantime showed that Listerine® fulfils the consensus criteria for an effective antigingivitis/antiplaque product. However, concerns have been raised about the long-term safety of some of the ingredients, particularly the ethanol content, and in the light of these concerns, the evidence has been re-examined for both the efficacy and safety of Listerine®. In summary, the studies support the claim that Listerine® shows benefit for oral health, but the concerns over its safety remain to be clarified. Until these have been addressed, high risk populations (children, alcohol addicts, patients with genetic deficiencies in ethanol metabolism) should use alcohol-free mouthwashes for the maintenance of oral health.

Efficacy of essential oil mouthwash with and without alcohol: a 3-day plaque accumulation model

Background

The aim of this study was to evaluate the antiplaque effect of a new alcohol free essential oil mouthwash with respect to a control of an essential oil with alcohol mouthwash, using an in vivo plaque regrowth model of 3-days.

Methods

The study was designed as a double-masked, randomized, crossover clinical trial, involving 30 volunteers to compare two different essential oil containing mouthwashes, during a 3-day plaque accumulation model. After receiving a thorough professional prophylaxis at the baseline, over the next 3-days each volunteer refrained from all oral hygiene measures and had two daily rinses with 20 ml of the test mouthwash (alcohol free essential oil) or the control mouthwash (essential oil with alcohol). At the end of the each experimental period, plaque was assessed and the panelists filled out a questionnaire. Each subject underwent a 14 days washout period and there was a second allocation.

Results

The essential oil mouthwash with ethanol shows a better inhibitory effect of plaque regrowth in 3-days than the mouthwash test with only essential oil in the whole mouth (plaque index = 2.18 against 2.46, respectively, p < 0.05); for the lower jaw (plaque index = 2.28 against 2.57, respectively, p < 0.05); for the upper jaw (plaque index = 2.08 against 2.35, respectively, p < 0.05); for the incisors (plaque index = 1.93 against 2.27, respectively, p < 0.05); and the canines (plaque index = 1.99 against 2.47, respectively, p < 0.05).

Conclusion

The essential oil containing mouthwash without alcohol seems to have a less inhibiting effect on the plaque regrowth than the traditional alcoholic solution.

Trial Registration

ClinicalTrials.gov NCT01411618

Habits with killer instincts: in vivo analysis on the severity of oral mucosal alterations using autofluorescence spectroscopy

Oral habits like chewing and smoking are main causes of oral cancer, which has a higher mortality rate than many other cancer forms. Currently, the long term survival rate of oral cancer is less than 50%, as a majority of cases are detected very late. The clinician's main challenge is to differentiate among a multitude of red, white, or ulcerated lesions. Hence, new noninvasive, reliable, and fast techniques for the discrimination of oral cavity disorders are to be developed. This study includes autofluorescence spectroscopic screening of normal volunteers with and without lifestyle oral habits and patients with oral submucous fibrosis (OSF). The spectra from different sites of habitués, non-habitués, and OSF patients were analyzed using the intensity ratio, redox ratio, and linear discriminant analysis (LDA). The spectral disparities among these groups are well demonstrated in the emission regions of collagen and Flavin adenine dinucleotide. We observed that LDA gives better efficiency of classification than the intensity ratio technique. Even the differentiation of habitués and non-habitués could be well established with LDA. The study concludes that the clinical application of autofluorescence spectroscopy along with LDA, yields spontaneous screening among individuals, facilitating better patient management for clinicians and better quality of life for patients.

Biocompatibility of orthodontic adhesives in rat subcutaneous tissue

Objective

The objective of the present study was to verify the hypothesis that no difference in biocompatibility exists between different orthodontic adhesives.

Material and Methods

Thirty male Wistar rats were used in this study and divided into five groups (n=6): Group 1 (control, distilled water), Group 2 (Concise), Group 3 (Xeno III), Group 4 (Transbond XT), and Group 5 (Transbond plus Self-Etching Primer). Two cavities were performed in the subcutaneous dorsum of each animal to place a polyvinyl sponge soaked with 2 drops of the respective adhesive in each surgical loci. Two animals of each group were sacrificed after 7, 15, and 30 days, and their tissues were analyzed by using an optical microscope.

Results

At day 7, Groups 3 (Transbond XT) and 4 (Xeno III) showed intense mono- and polymorphonuclear inflammatory infiltrate with no differences between them, whereas Groups 1 (control) and 2 (Concise) showed moderate mononuclear inflammatory infiltrate. At day 15, severe inflammation was observed in Group 3 (Transbond XT) compared to other groups. At day 30, the same group showed a more expressive mononuclear inflammatory infiltrate compared to other groups.

Conclusion

Among the orthodontic adhesive analyzed, it may be concluded that Transbond XT exhibited the worst biocompatibility. However, one cannot interpret the specificity of the data generated in vivo animal models as a human response.

Effects of ethanol and extract of cigarette smoke on the rabbit buccal mucosa

AIM

The combination of smoking and drinking alcohol has a high association with diseases of squamous epithelium within the human oral cavity. Therefore, a study was done to assess the impact of these agents alone or in combination on the squamous epithelium using as model the buccal epithelium from rabbit oral cavity.

METHODS

Buccal epithelium was mounted in Ussing chambers to monitor electrical parameters during exposure to ethanol (5-40%) or to Ringer extract of cigarette smoke (EOCS) from one to six cigarettes dissolved in 10 ml Ringer either alone or with combination.

RESULTS

Exposure to EOCS reduced in a dose dependent manner above 2 cigarettes/10 ml transmural electrical potential difference (PD), short-circuit current (I(sc)), increased transmural electrical resistance (R). Morphology showed from generalize tissue edema to patchy necrosis with the increasing concentrations. Ethanol alone raised PD, I(sc) and R at lower concentrations (5%) and lowered PD, I(sc) and R at higher concentrations (40%). The combination of 5% ethanol, EOCS-1cigarette/10 ml reduced PD, I(sc) by 58% and increased R by 29%. Unlike exposure to 5% EtOH and EOCS-1, 10% EtOH combined with EOCS-1 produces a harmful effect by dropping PD and I(sc).

CONCLUSION

Both, simultaneous, and sequential, use of these agents enhanced their negative impact on these parameters. The enhancement of these effects are not due to solubulization of additional tobacco products by EtOH or by or by EtOH enhancing smoking noxious effect. Histopathologic damage needs higher concentrations of ethanol and EOCS combination and changes were more profound compared to the sum of the isolated effects of both agents.

Socioeconomic status and head and neck cancer

DESIGN

This was a population-based case-control study. CASE-CONTROL SELECTION: Eligible patients were aged between 18 and 80 years and had a primary histopathological diagnosis made between April 2002 and December 2004. Diagnosis included malignant cancers of the oral cavity, oropharynx, hypopharynx or larynx. Incident cases were identified through weekly monitoring of head and neck cancer clinics in hospital departments and were confirmed by pathology department records. Controls matched by age (5-year age band) and sex were randomly selected from the lists of general practitioners.

DATA ANALYSIS

Information about occupation, education, smoking and alcohol consumption was collected at personal interview. Socioeconomic circumstances were measured at an individual level (education, occupational social class, unemployment), and by area-based measures of deprivation. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were computed by unconditional logistic regression and were adjusted for age and sex. This model was repeated to assess for potential independent effects of the range of socioeconomic components after adjusting for smoking and alcohol consumption. Interactions between smoking and consumption of alcohol, and between individual and area-based measures for socioeconomic factors were tested by the likelihood ratio test. In addition, the most important behavioural risk factors and socioeconomic variables were entered into a stepwise multivariate logistic regression model. All statistical analyses were carried out using Statistical Analysis System (SAS; Cary, North Carolina, USA) software.

RESULTS

The study population included 103 cancer patients (38 women and 65 men), and 91 controls (39 women and 52 men). Individuals living in the most deprived areas (OR, 4.66; 95% CI, 1.79- 12.18) and those who were unemployed (OR, 2.27; 95% CI, 1.21- 4.26) had a significantly higher risk of cancer than people who had high levels of educational attainment (OR, 0.17; 95% CI, 0.05-0.58). Significance was lost for all measures of social class when adjustments were made for smoking and consumption of alcohol. When the most important behavioural and socioeconomic factors were combined in a fully adjusted multivariate analysis, smoking was the only significant risk factor (OR, 15.53; 95% CI, 5.36-44.99) found to be independently associated with head and neck cancers.

CONCLUSIONS

A high risk of head and neck cancer was consistently associated with poor socioeconomic circumstances. There were strong links for specific components but smoking dominated the overall profile of risk. More detailed research into the nature of such associations is needed in the future.

Effects of acute alcohol consumption and vitamin E co-treatment on oxidative stress parameters in rats tongue

The aim of this study was to evaluate the effects of acute alcohol consumption and vitamin E co-treatment upon oxidative stress parameters in rats tongue. Thirty-eight, Wistar rats were separated into five groups (alcohol, alcohol/vitamin E, control, Tween, vitamin E). Alcohol and alcohol vitamin E groups had the standard diet, and 40% alcohol on drinking water. Other groups were fed with the same standard diet and water ad libitum. Vitamin E was given by gavage to vitamin E and alcohol/vitamin E rats twice a week. Alcohol and control groups were subjected to saline gavage and Tween group to 5% Tween 80 solution, the vitamin E vehicle. At day 14, the animals were anesthetized and specimens were obtained from tongue. Lipid peroxidation (TBARS), protein oxidative damage, catalase (CAT) and superoxide dismutase (SOD) activities were quantified. Alcohol group decreased TBARS in relation to control group and alcohol vitamin-treated animals decreased TBARS when compared to Tween and vitamin E groups. SOD activity was lower and CAT activity was higher in animals treated with both alcohol and vitamin E. These results suggest that short-term alcohol consumption decreases lipid peroxidation levels. Alternatively, alcohol/vitamin E group increased CAT, showing the toxicity of this association.

Quantitation of pyridyloxobutyl DNA adducts in nasal and oral mucosa of rats treated chronically with enantiomers of N'-nitrosonornicotine

N'-Nitrosonornicotine (NNN) is one of the most important strong carcinogens in tobacco products and is believed to play a significant role in the induction of esophageal cancer in smokers and oral cavity cancer in snuff dippers. NNN is metabolically activated through cytochrome P450-catalyzed alpha-hydroxylation. 2'-Hydroxylation produces a reactive intermediate 4-(3-pyridyl)-4-oxobutanediazohydroxide (7), which alkylates DNA to form pyridyloxobutyl (POB)-DNA adducts. DNA pyridyloxobutylation from NNN treatment, as measured by released 4-hydroxy-1-(3-pyridyl)-1-butanone (HPB, 8), has been observed in vitro and in vivo. In the present study, we have used liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) to analyze specific POB-DNA adducts in the nasal olfactory, nasal respiratory, and oral mucosa of F344 rats treated chronically with (R)-NNN or (S)-NNN in the drinking water (10 ppm, 1-20 weeks). Adduct levels in the nasal respiratory mucosa exceeded those in the nasal olfactory and oral mucosa. (R)-NNN treatment generated 2-4 times more adducts in the nasal olfactory and respiratory mucosa than did (S)-NNN at most time points. O(2)-[4-(3-Pyridyl)-4-oxobut-1-yl]thymidine (O(2)-POB-dThd, 11) predominated in the nasal olfactory and respiratory mucosa, followed by 7-[4-(3-pyridyl)-4-oxobut-1-yl]guanine (7-POB-Gua, 14). Levels of O(2)-[4-(3-pyridyl)-4-oxobut-1-yl]cytosine (O(2)-POB-Cyt, 13) and O(6)-[4-(3-pyridyl)-4-oxobut-1-yl]-2'-deoxyguanosine (O(6)-POB-dGuo, 12) were significantly lower. In the oral mucosa, the opposite stereoselectivity was observed, with (S)-NNN treatment producing 3-5 times more POB-DNA adducts than did (R)-NNN. O(2)-POB-dThd and 7-POB-dGuo were the two major adducts, and their levels were similar. Overall, POB-DNA adduct formation in the nasal olfactory and nasal respiratory mucosa was similar to that previously observed in the lung, whereas in the oral mucosa, the trend resembled that in the esophagus. These results indicate that different mechanisms are involved in NNN metabolism and tumorigenesis in rat nasal and oral tissues. NNN enters the nasal mucosa through the circulation, and tissue-specific metabolism is important, while in the oral mucosa, direct exposure and local activation both play significant roles. Our results also support the potential importance of NNN as an oral carcinogen in people who use smokeless tobacco products.

The additive effect of ethanol and extract of cigarette smoke on rabbit esophagus epithelium

AIM

The combination of alcohol and smoking takes a place in the epidemiology and pathogenesis of gastroesophageal reflux disease and squamous cancers of the esophagus. Therefore, a study was designed to assess the impact of these agents alone or in combination on the structure and function of squamous epithelium of rabbit esophagus.

METHODS

Rabbit esophageal epithelium was mounted in Ussing Chambers, exposed luminally for ethanol (1-10%), extract of cigarette smoke (EOCS) and combinations or sequential application of these agents. An in-vivo model was also used to mimic conditions more representative of human alcohol consumption.

RESULTS

Ethanol (1-10%) dose dependently decreased tissue resistance. Extract of cigarette smoke caused a reduction on transepithelial potential difference (PD), short circuit current. Combinations of EOCS, ethanol (5-10% EtOH and EOCS 1-2) showed a more pronounced decrease than agents alone, mainly the result of EOCS. In vivo studies showed that EOCS administration dropped PD dose dependently. In-vivo 10% EtOH, EOCS-2 dropped PD (55%) similar to in-vitro 5% EtOH, EOCS-1. The effect was clearly additive; boluses of 10% ethanol (36%) and EOCS-2 (17%) decreased PD and combination of agents resulted in a 55% drop on PD which is a very similar decrease compared to the sum of the separate effects of agents (53%).

CONCLUSION

Ethanol affected the barrier and cigarette smoke altered ion transport on rabbit esophageal epithelium under conditions reflecting human consumption. Results were consistent with in vivo and in vitro conditions except higher concentrations were needed in vivo. When applied, these agents showed an additive effect. Ethanol predisposed the tissue to the effect of EOCS.

Type of alcoholic beverage and risk of head and neck cancer--a pooled analysis within the INHANCE Consortium

The authors pooled data from 15 case-control studies of head and neck cancer (9,107 cases, 14,219 controls) to investigate the independent associations with consumption of beer, wine, and liquor. In particular, they calculated associations with different measures of beverage consumption separately for subjects who drank beer only (858 cases, 986 controls), for liquor-only drinkers (499 cases, 527 controls), and for wine-only drinkers (1,021 cases, 2,460 controls), with alcohol never drinkers (1,124 cases, 3,487 controls) used as a common reference group. The authors observed similar associations with ethanol-standardized consumption frequency for beer-only drinkers (odds ratios (ORs) = 1.6, 1.9, 2.2, and 5.4 for < or =5, 6-15, 16-30, and >30 drinks per week, respectively; P(trend) < 0.0001) and liquor-only drinkers (ORs = 1.6, 1.5, 2.3, and 3.6; P < 0.0001). Among wine-only drinkers, the odds ratios for moderate levels of consumption frequency approached the null, whereas those for higher consumption levels were comparable to those of drinkers of other beverage types (ORs = 1.1, 1.2, 1.9, and 6.3; P < 0.0001). Study findings suggest that the relative risks of head and neck cancer for beer and liquor are comparable. The authors observed weaker associations with moderate wine consumption, although they cannot rule out confounding from diet and other lifestyle factors as an explanation for this finding. Given the presence of heterogeneity in study-specific results, their findings should be interpreted with caution.

Cytotoxicity of Two Bonding Adhesives Assessed by Three-Dimensional Cell Culture

Objective: To determine the toxicity of orthodontic adhesives assessed on in vitro three-dimensional reconstructed human oral epithelium (RHOE).

Materials and Methods: Two adhesive primers, Transbond XT (3M, Monrovia, Calif) and Excite (Vivadent, Schaan, Liechtenstein), were tested. After topical exposure, the cell cultures were fixed, cut, and stained for light microscopy (LM) and transmission electron microscopy (TEM). Detection of cytotoxicity by measuring lactate dehydrogenase (LDH) activity was performed. Toxicity was assessed by evaluating the morphological changes with LM and TEM. Copper wires and Triton X-100 served as positive controls, and native cell cultures as negative control.

Results: Morphological evaluation of the native cell cultures revealed no toxic reactions. The LDH assay revealed the following mean values for viability: native cell line (negative control), 1.51; Triton X-100 (positive control), 3.06; Transbond XT polymerized, 1.15; Excite polymerized, 1.11; Transbond XT primer, 2.67; and Excite primer, 0.04. Acute toxicity was observed for Triton X-100 and Transbond XT primer (P &lt; .001). Histological evaluation of the RHOE showed toxicity for both primers and mild changes after topical application of polymerized adhesives. The biocompatibility ranking of the adhesive primers was the same after histological analysis and LDH assay except for Excite™ noncured.

Conclusions: RHOE proved to be a valuable model for topical exposure. The toxicity of both uncured primers was demonstrated.

Glutathione S-transferase polymorphisms and the synergy of alcohol and tobacco in oral, pharyngeal, and laryngeal carcinoma

Investigations of the ability of polymorphisms in the GSTM1, GSTT1, and GSTP1 genes to alter susceptibility to head and neck squamous cell carcinoma (HNSCC) have examined gene-environment interaction in their detoxification of tobacco-associated carcinogens. Little work has been done to ask if these variant genes also modify the interaction of tobacco and alcohol in the development of HNSCC. To test this hypothesis, we conducted a case-control study, enrolling 692 incident cases of HNSCC and 753 population controls. Information about lifetime tobacco and alcohol use was ascertained through questionnaires, and genotypes for GSTM1, GSTT1, and GSTP1 were determined from constitutional DNA. Genotype frequencies were compared among cases and controls, and the association between genotypes and tobacco use was evaluated on cancer risk through logistic regression. Deletion of GSTM1 was associated with an increased risk for HNSCC [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 1.0-1.6]. GSTT1 deletion was associated with a slight decreased HNSCC risk (OR, 0.8; 95% CI, 0.6-1.0). Among those with GSTM1 present, the OR of cancer for heavy smoking was 2.6 (95% CI, 1.6-4.3) compared with 4.2 for those with the GSTM1 deleted (95% CI, 2.6-6.7). The combination of consuming 10 to 20 alcohol drinks weekly and smoking >45 pack-years was associated with a 13-fold elevated risk (OR, 12.6; 95% CI, 4.0-40.2) among the GSTM1 deleted subjects compared with an OR of 3.6 (95% CI, 1.5-8.7) among the GSTM1 present individuals. These data (showing that the GSTM1 deletion affects on the tobacco and alcohol synergy) suggest that the interaction of these carcinogens is, at least in part, driven by alcohol, enhancing the carcinogenic action of tobacco smoke.

H3 and H3.3 histone mRNA amounts and ratio in oral squamous cell carcinoma and leukoplakia

Histone variants (e.g. H3) play an important role in chromatin structure and gene expression regulation of normal cells. Aims of this study were to: (1) estimate H3 and H3.3 histone mRNA expressions and their ratio in oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL); (2) investigate whether H3 and H3.3 variants could play a role in the pathogenesis of OSCC and OL, also conditionally to HPV infection, age, gender, and main habits (tobacco smoking and alcohol drinking) in human beings studied. Twenty-three cases of OSCC and 20 cases of OL were examined in lesion site (LS) and juxtaposed clinically undamaged site (JUS) by RT-PCR for H3 and H3.3 histone mRNA; 13 healthy oral mucosa samples (HS) were investigated in a single site as controls. HPV DNA presence was investigated in the respective exfoliated oral mucosa cells by nested PCR (nPCR: MY09-MY11/GP5-GP6). The data showed that both H3 and H3.3 histone mRNA crude concentrations are higher in OSCC (LS = 2901 +/- 459 ng of H3; JUS = 2699 +/- 658 ng of H3; LS = 3190 +/- 411 ng of H3.3; JUS = 2596 +/- 755 ng of H3.3) than those in OL (LS = 2095 +/- 349 ng of H3; JUS = 2192 +/- 897 ng of H3; LS = 2076 +/- 911 ng of H3.3; JUS = 1880 +/- 654 ng of H3.3) and in HS (2579 +/- 959 ng of H3; 2300 +/- 758 ng of H3.3), although not reaching any statistical significance. Interestingly, ratio of H3/H3.3 mRNA amounts decrease both in OSCC (0.99) and OL (1.009) vs HS (1.121). No association was found for H3 and H3.3 histone mRNA expressions in OSCC and OL with respect to HPV infection and the social-demographical variables considered (P > 0.2). The overall higher expression of H3.3 in damaged tissues up to the ratio inversion in OSCC especially in HPV+ alcohol drinkers (60.0%) represents the most interesting finding, in consideration of the proven ability of alcohol to act as permeability enhancer of human oral mucosa, to alter the mucosal structure and by this dynamics could favour the penetration through the epithelial layers of HPV.

Buccal penetration enhancers--how do they really work?

Certain agents that increase drug delivery through the skin, including surfactants, bile salts, and fatty acids, have been shown to exert a similar effect on the buccal mucosa. These agents enhance skin permeability by interacting with and disrupting the ordered intercellular lipid lamellae within the keratinized stratum corneum, and it has been assumed that a similar mechanism of action occurs in the nonkeratinized buccal mucosa. However, the chemical and structural nature of the lipids present within the intercellular regions of the buccal mucosa is quite different to that found within the stratum corneum, and so extrapolation of results between these two tissues may be misleading. To assume that the mechanism of action of buccal penetration enhancers is based on the disruption of intercellular lipids may be erroneous, and may result in the inappropriate prediction that certain skin penetration enhancers will similarly enhance drug delivery through the buccal mucosa. The data available in the literature suggest that agents that enhance buccal penetration exert their effect by a mechanism other than by disruption of intercellular lipids. Rather, buccal penetration enhancement appears to result from agents being able to (a) increase the partitioning of drugs into the buccal epithelium, (b) extract (and not disrupt) intercellular lipids, (c) interact with epithelial protein domains, and/or (d) increase the retention of drugs at the buccal mucosal surface. The purpose of this review is to identify the major differences in the structural and chemical nature of the permeability barriers between the buccal mucosa and skin, to clarify the mechanisms of action of buccal penetration enhancers, and to identify the limitations of certain models that are used to assess the effect of buccal penetration enhancers.

Alcohol and oral cancer

Alcohol, particularly when associated with tobacco use, has been recognized as an important risk factor for mouth cancer for almost 50 years. Together, they are associated with approximately 75% of upper aerodigestive tract cancers. However, intake of alcohol remains high in many countries. The rising incidence of oral cancer has prompted a revaluation of the role of alcohol (both alone and in partnership with other etiologic agents). In this article, the potential role of alcohol in the development of oral cancer is reviewed. In particular, the effect of alcohol on cellular structure and function is considered by reference to histologic and exfoliative cytologic studies of the oral epithelia. Alcohol may influence the proliferative cells by both intracellular (e.g., endocytosis) and intercellular (permeability) pathways. The carcinogenic exposure of the proliferating stem cells in the basal layer may be regulated through these pathways. Individual variation might help explain why oral cancer arises in some, but not in most, people who smoke and consume excess alcohol. Despite this finding, alcohol is strongly associated with the development of oral cancer and other upper aerodigestive tract cancers. Efforts to reduce this burden on the individual and society must be directed toward patient and professional education and research regarding (genetic) susceptibility.

Alcohol-related diseases of the mouth and throat

Chronic consumption of alcoholic beverages is an accepted social custom worldwide. In the upper aerodigestive tract, local morphologic, metabolic and functional alterations are present due to alcohol consumption. A clinical link between the chronic consumption of alcohol and head and neck cancer has been observed for decades. While alcohol was described initially as a risk enhancer only in smokers, a number of epidemiological studies have now provided sufficient evidence that chronic alcohol consumption increases the risk of head and neck cancer independent of exposure to tobacco smoke. The systemic effects of alcohol interact with local changes in the morphology and function of the salivary glands. In addition, alcohol leads to accumulation of pathologic microbes within the mucosa, leading to chronic infection. Susceptibility to carcinogens and cell proliferation in the mucosa are increased, resulting in genetic changes with the development of dysplasia, leukoplacia and carcinoma. Chronic alcohol consumption is correlated with an increased risk of cancer and an increased mortality in a dose-effect relationship. A number of biologically plausible mechanisms exist by which alcohol may cause cancer. These mechanisms are discussed in this article.

[Alcohol related diseases of the head and neck]

Chronic consumption of alcohol is an accepted social custom worldwide. In the upper aerodigestive tract, local morphologic, metabolic and functional alterations can be present due such consumption. Gastroesophageal reflux or alterations in sleep structure are typical examples of functional disorders. While alcohol was initially described as a risk enhancer only in smokers, a number of epidemiological studies have now shown that chronic alcohol consumption increases the risk of head and neck cancer independently of exposure to tobacco smoke. In addition, alcohol leads to an accumulation of pathologic microbes within the mucosa, leading to chronic infection. Susceptibility to carcinogens and cell proliferation in the mucosa are increased, resulting in genetic changes with the development of dysplasia, leucoplakia and carcinoma. Chronic alcohol consumption is correlated with an increased risk of cancer and increased mortality in a dose-dependent relationship. A number of biologically plausible mechanisms exist by which alcohol may cause cancer.

Modification of buccal drug delivery following pretreatment with skin penetration enhancers

The effect of the lipophilic skin penetration enhancers octisalate (OS), padimate O (PO), and Azone (AZ) on in vitro buccal permeability was assessed using caffeine (CAF), estradiol (E2), and triamcinolone acetonide (TAC) as model permeants. Buccal permeability was assessed in modified Ussing chambers, through both untreated porcine buccal mucosa and mucosa pretreated with an enhancer (5% w/v in 95% v/v ethanol) or ethanol alone. To ensure sink conditions were present, E2 permeability experiments were also performed with bovine serum albumin (BSA) 4% in the receptor solution. Mucosa-buffer partition studies were performed to determine the effect of enhancer pretreatment on the log mucosa-buffer partition coefficient (logK) of E2 and TAC. CAF permeability was only increased following pretreatment with ethanol 95%. E2 buccal transport was not altered following OS pretreatment, but was reduced by 26.3% with PO pretreatment and 67.6% with AZ pretreatment. Similar results were obtained with BSA 4% in the receptor solution. The logK of E2 was increased 1.4-fold and 2.2-fold in PO- and AZ-pretreated tissues, respectively, suggesting that the reduction in flux caused by PO and AZ may have been due to enhanced E2 tissue retention. The effect of OS and PO on TAC permeability was no different to that of ethanol. However, AZ enhanced TAC permeability 4.1-fold and this was accompanied by a 2.4-fold increase in the logK of TAC.

Effect of ethanol on lipid metabolism and epithelial permeability barrier of skin and oral mucosa in the rat

BACKGROUND

Ethanol consumption induces changes in lipid metabolism. This might be reflected locally as an alteration in the epithelial lipid barrier.

METHODS

Rats were fed with an isocaloric liquid diet with, or without, ethanol (6.7%) and were sacrificed at 60 or 120 days. Plasma and liver triglycerides, gamma-glutamyl-transferase (GGTP) levels, and permeability (Kp) of skin and buccal mucosa to tritiated water and the tobacco carcinogen, nitrosonornicotine, were determined.

RESULTS

Significant elevation of GGTP at 120 days and triglycerides at both 60 and 120 days was observed for rats fed with ethanol diet. For this diet, Kp values to both penetrants increased significantly for skin in rats after 120 days compared to all other groups.

CONCLUSION

The parallel between changes in lipid metabolism and permeability suggests that one effect of ingested alcohol is to alter the lipid-containing permeability barrier of stratified squamous epithelium.

The permeability of oral leukoplakia

The significant increase in oral cancer mortality necessitates further research on the mechanisms of tumorigenesis. It was the aim of this study to compare the permeability, lipid composition and histopathological characteristics of oral leukoplakia with non-lesional specimens of the same region in 30 cases as well as 11 specimens originating from healthy control buccal mucosa. The permeability (Kp) of tissue biopsies to tritiated nitrosonornicotine was determined in a continuous through-flow perfusion system, lipids were extracted and identified by thin-layer chromatography, and thickness of epithelium and keratin layer assessed by histopathological methods. Results of the measurements showed that the permeability to the tobacco carcinogen, nitrosonornicotine for leukoplakic tissue was higher than for normal control buccal specimens. Non-lesional areas of buccal mucosa, adjacent to leukoplakias, showed hyperplasia and significantly higher permeability values than both leukoplakic and normal buccal control mucosa. The lipid content of the non-lesional sites was intermediate between the increased values of the leukoplakic lesion and of normal control mucosa. The data strongly suggest that the presence of tobacco in the oral cavity may bring about generalized changes even in regions that do not show leukoplakia.

Alcohol-related diseases of the mouth and throat

Chronic consumption of alcoholic beverages is an accepted social custom worldwide. In the upper aerodigestive tract, local morphological, metabolic and functional alterations can be present as a result of alcohol consumption. A clinical link between the chronic consumption of alcohol and head and neck cancer has been observed for decades. While alcohol was described initially as a risk enhancer only in smokers, a number of epidemiological studies have now provided sufficient evidence that chronic alcohol consumption increases the risk of head and neck cancer independent of exposure to tobacco smoke. Systemic effects of alcohol interact with local changes in the morphology and function of the salivary glands. In addition, alcohol leads to the accumulation of pathological microbes within the mucosa, leading to chronic infection. Susceptibility to carcinogens and cell proliferation in the mucosa are increased, resulting in genetic changes with the development of dysplasia, leucoplakia and carcinoma. Chronic alcohol consumption has been correlated with an increased risk of cancer and increased mortality in a dose-effect relationship. A number of biologically plausible mechanisms exist by which alcohol may cause cancer. These mechanisms are discussed in this chapter.

Proliferating cell nuclear antigen expression on tongue of mice after intake of, or topical exposure to, alcohol

The purpose of the current study was to evaluate the effects of alcohol on cellular proliferation. Sixty mice were separated into three groups of 20 mice in each. The first group, exposed to alcohol continuously, ingested 40% [volume/volume (vol./vol.)] alcohol instead of water during the experiment. For the second group, exposed to alcohol topically, alcohol was applied to the dorsum of the tongue twice a week. The third group served as the control group. We used the proliferating cell nuclear antigen (PCNA) immunohistochemical expression technique to perform quantitative measurements of cellular proliferation in the basal and intermediate layers of the epithelial tissue of the tongue. Cell proliferation was quantified at three different time points: just before the beginning of the experiment and at 6 and 12 months. Results were compared for mice in each group and for the three groups. At 12 months, we observed an increase in cellular proliferation in the intermediate layer of the epithelium of mice in the group that consumed alcohol (P=.01). Results for topical alcohol-exposed and control groups did not show significant differences in cellular proliferation at any time point during the study. We concluded that the effects of alcohol on cellular proliferation may be caused by continuous intake of alcohol and occur throughout life.

Acetaldehyde activates Jun/AP-1 expression and DNA binding activity in human oral keratinocytes

Oral cancer is a significant health problem, particularly among individuals that ingest alcohol in combination with the use of tobacco products. The enhanced development of tobacco-initiated oral cancers by ethanol suggests that ethanol or one of its metabolites may act as a type of tumor promoter. Nevertheless, the mechanisms underlying the ability of ethanol to enhance oral carcinogenesis remain unclear. We hypothesize that acetaldehyde, the first metabolite of ethanol, may activate the expression and/or activity of Jun/AP-1 in oral keratinocytes analogous to the phorbol ester TPA and other tumor promoters in epidermal keratinocytes. To test this hypothesis, we treated HPV immortalized, non-tumorigenic human oral keratinocytes with acetaldehyde at various concentrations and for various times and measured several parameters of Jun/AP-1expression and function. Our results indicated that c-Jun mRNA and protein levels increased in the acetaldehyde treated cells compared to untreated control cells. Moreover, Jun/AP-1 DNA binding activity was rapidly activated by acetaldehyde in a dose-dependent fashion. The increases in Jun protein and AP-1 DNA binding activity were accompanied by increased transactivation of an AP-1 responsive reporter construct as well as increased transcript levels of a candidate AP-1 responsive gene, stromelysin 3. The levels of acetaldehyde employed were minimally toxic to the cells as determined by MTT assays. Thus, acetaldehyde was found to activate the expression and activity of an oncogenic transcription factor in HPV-initiated cells. Taken together, these results suggest that acetaldehyde may participate, at least in part, in the promotion stage of oral carcinogenesis.

Permeation of a myristoylated dipeptide across the buccal mucosa: topological distribution and evaluation of tissue integrity

The ex vivo permeation of an acylated model dipeptide, Myristoyl-Tryptophan-Leucine (Myr-Trp-Leu) was studied using pig buccal mucosa. Myr-Trp-Leu, being lipophilic, did not readily penetrate across the membrane. Rather, it accumulated in the epithelial and connective tissue of the mucosal barrier. The topological distribution of Myr-Trp-Leu across the mucosa, following its application in ethanol/phosphate buffer (30/70 pH 7.4), was determinated by thin-sectioning of the tissue, extraction of the peptide, and high performance thin layer chromatography (HPTLC). The concentration profile depended, of course, on the duration of the experiment and appeared to be dependent upon the presence of sufficient ethanol in order that the peptide could be solubilized. This important role for ethanol then raised the question of the solvent's effect on tissue integrity. Light microscopic examination of the mucosa was, therefore, undertaken, under identical conditions to those used in the permeation experiments, to evaluate any perturbation induced by the ethanolic vehicle. No obvious effects were observed.

Short-term exposure to alcohol increases the permeability of human oral mucosa

OBJECTIVES

The aim of this study was to evaluate the effect of short-term exposure to ethanol on the permeability barrier properties of human oral mucosa.

MATERIALS AND METHODS

Permeability constants (Kp x 10(-4) cm min(-1)) to tritiated water were determined, for untreated human ventral tongue, and following treatment with phosphate-buffered saline (PBS), 5, 15 or 40% ethanol using an in vitro perfusion chamber system. Some samples were also exposed to fluorescent-labelled albumin and examined by fluorescence microscopy. Permeability barrier lipid composition was assessed in treated and untreated mucosa by heat separation, solvent extraction and thin layer chromatography.

RESULTS

Fifteen per cent ethanol significantly increased mucosal permeability (5.8 +/- 0.44; P < 0.05) compared with untreated, PBS and 5% ethanol treated mucosa (4.69 +/- 0.26, 4.48 +/- 0.3 and 4.13 +/- 0.27, respectively). Albumin was restricted to the epithelial surface in control tissue, but extended further through the epithelium and, in some cases, into the connective tissue after treatment with ethanol. Biochemical analysis revealed no significant difference in the epithelial lipid composition of treated and untreated mucosa.

CONCLUSIONS

These results suggest that short-term exposure to ethanol may act as a permeability enhancer, possibly by causing molecular rearrangement of the permeability barrier, not as a result of lipid extraction.

Diffusion of dialkylnitrosamines into the rat esophagus as a factor in esophageal carcinogenesis

To indicate how readily nitrosamines (NAms) diffuse into the esophagus, we measured diffusion rate (flux) through rat esophagus of dialkyl-NAms using side-by-side diffusion apparatuses. Mucosal and serosal flux at 37 degrees C of two NAms, each at 50 microM, was followed for 90 min by gas chromatography-thermal energy analysis of NAms in the receiver chamber. Mucosal flux of one or two NAms at a time gave identical results. Mucosal flux was highest for the strong esophageal carcinogens methyl-n-amyl-NAm (MNAN) and methylbenzyl-NAm. Mucosal esophageal flux of 11 NAms was 18-280 times faster and flux of two NAms through skin was 13-28 times faster than that predicted for skin from the molecular weights and octanol:water partition coefficients, which were also measured. Mucosal: serosal flux ratio was correlated (P < 0.05) with esophageal carcinogenicity and molecular weight. For seven NAms tested for carcinogenicity by Druckrey et al. [(1967) Z. Krebsforsch., 69, 103-201], mucosal flux was correlated with esophageal carcinogenicity with borderline significance (P = 0.07). The MNAN:dipropyl-NAm ratio for mucosal esophageal flux was unaffected when rats were treated with phenethylisothiocyanate and was similar to that for forestomach, indicating no involvement by cytochromes P450. Mucosal esophageal flux of MNAN and dimethyl-NAm was reduced by >90% on enzymic removal of the stratum corneum, was unaffected by 0.1 mM verapamil and was inhibited 67-94% by 1.0 mM KCN and 82-93% by 0.23% ethanol. NAm flux through rat skin and jejunum was 5-17% of that through esophagus. Flux through skin increased 5-13 times after enzymic or mechanical removal of the epidermis; the histology probably explained this difference from esophagus. Hence, NAms could be quite rapidly absorbed by human esophagus when NAm-containing foods or beverages are swallowed, the esophageal carcinogenicity of NAms may be partly determined by their esophageal flux and NAm flux probably occurs by passive diffusion.

Fluid phase endocytosis within buccal mucosal cells of alcohol misusers

The structure of the oral mucosa is now well characterised, although studies on oral epithelial cell function have received less attention. The aims of this study were to see whether endocytosis could be demonstrated in cells from oral smears and if so, to assess the effect of chronic high alcohol intake on such uptake. Buccal mucosal smears were collected from 135 patients (91 non- or social drinkers, and 44 patients with harmful alcohol use). Name, age, sex, and alcohol history (for alcohol problem patients) were recorded. Cell suspensions were incubated in a solution of bovine serum albumin (BSA)-coated fluorescently labelled latex microspheres (0.02 micron diameter) in Ham's F-10 culture medium for 1 h at 37 degrees C as a marker of fluid phase endocytosis. Uptake of microspheres was confirmed by confocal microscopy, and mean endocytosed fluorescence levels determined by flow cytometry. A repeat smear from 11 of the alcohol patients was taken 9-14 days later. Endocytosis was significantly reduced in both male (P < 0.01) and female (P < 0.01) alcohol problem patients compared to controls. Units of alcohol consumed and cigarettes smoked per day did not show a dose-response correlation with endocytosis in the alcohol problem patients. Apparent abstinence from alcohol had no further effect on endocytic uptake at days 9-14. This study shows that normal oral squamous cells removed as buccal smears readily endocytose fluorescent microspheres and that this capacity can be affected by alcohol. Chronic high alcohol intake would appear to down regulate endocytosis in buccal cells even up to 14 days of abstinence. This may have implications for the pathogenesis of oral mucosal disorders in long-term users.

Neuronal nicotinic acetylcholine receptors in rat trigeminal ganglia

The application of nicotine to the various epithelia served by the trigeminal nerve produces irritation and/or pain by activating neuronal nicotinic acetylcholine receptors (NnAChRS) in sensory neurons. In this study the NnAChRs were identified in rat trigeminal ganglia (TG) using RT-PCR and immunocytochemistry. With RT-PCR the subunits of NnAChRs in rat TG were determined, and with immunocytochemistry the localization of three prominent subunits (alpha 7, alpha 4 and beta 2) were localized in intact TG neurons. The relative abundance of the alpha and beta subunits were: alpha 7 approximately alpha 3 > alpha 6 > alpha 4 approximately alpha 5 > alpha 9 > or = alpha 2, and beta 2 approximately beta 3 > beta 4. This is the first report of the alpha 9 subunit in TG. Immunohistochemical studies revealed that almost all TG neurons contained alpha 7-LI and alpha 4-LI, and that 85% had beta 2-LI. For these three subunits much of the label was internalized. Immunocytochemical studies using antibodies raised against chick alpha 8 subunits did not specifically label rat TG. These data reveal that rat TG neurons contain the entire spectrum of mammalian NnAChR subunits.

Possible mechanisms by which alcohol may influence the development of oral cancer--a review

Although pure ethanol has never been shown to be carcinogenic in laboratory experiments, alcoholic beverages are now recognised as being important aetiological factors in the development of oral cancer. Despite this, the exact mechanism by which alcohol may exert an influence upon the oral mucosa has received less attention. An overview of the association of alcohol and oral cancer, both in combination with tobacco and without, is provided and consideration given to some of the pathways by which alcohol exerts its effect upon the oral mucosa.

Aetiology of oral cancer: alcohol

The effect of alcohol alone on the oral mucosa and its association with the development of oral cancer is difficult to establish, principally because alcohol consumption histories are difficult to verify, alter over time, both with respect to beverage type and quantity, and are frequently confounded by tobacco use. This review considers the various pathways by which alcohol may exert such an influence. Namely, due to topical exposure (e.g. direct effect on cell membranes, altered cell permeability, variation in enzymes that metabolise alcohol) and/or systemic effects (e.g. nutritional deficiency, immunological deficiency, disturbed liver function). Finally, the numerous papers that have sought to establish the relative risk for oral cancer in association with alcohol intake are reviewed.