Evaluation of lactate dehydrogenase enzyme activity in saliva and serum of oral submucous fibrosis patients

Salivary and serum levels of lactate dehydrogenase in oral submucous fibrosis: A meta-analysis

BACKGROUND

The occurrence of oral submucous fibrosis (OSF) is often accompanied by an increase in lactate dehydrogenase (LDH) levels. In this meta-analysis, we compared the salivary and serum levels of LDH levels between OSF patients and controls.

MATERIAL AND METHODS

A comprehensive search was conducted in PubMed, Embase, Web of Science, and Cochrane Library from the establishment of the database to June 2023, and the quality of the studies was checked by the Newcastle-Ottawa Quality Assessment scale. The mean difference (MD) and 95% confidence interval (CI) were calculated using RevMan 5.4 software.

RESULTS

A total of 28 studies were retrieved from the database, and we included 5 studies in this meta-analysis. The salivary LDH level of OSF patients was higher than healthy controls (MD: 423.10 pg/L 95%CI: 276.42-569.77 pg/mL, P < .00001), the serum LDH level of OSF patients was also higher than that of healthy controls (MD: 226.20 pg/mL, 95%CI: 147.71-304.69 pg/mL, P < .00001).

CONCLUSIONS

This meta-analysis showed that salivary and serum LDH levels were higher in OSF patients than in healthy controls, suggesting that LDH may be a potential biomarker for OSF.

Lactate Dehydrogenase as a Biomarker in Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis was planned with the objective of evaluating the level of Lactate Dehydrogenase (LDH) in oral submucous fibrosis patients and in controls and comparing them. For this meta-analysis, we searched Google Scholar, PubMed, Scopus, and Directory of Open Access Journals (DOAJ) databases using a search methodology that included combinations of MeSH terms and keywords and included cross-sectional studies to evaluate the levels of LDH in patients with Oral Submucous Fibrosis (OSMF), Oral Squamous Cell Carcinoma (OSCC) and compared it with the controls. The total number of records identified through database searching was 4161 (n). Analysis of the quality of the studies was done using the National Heart, Lungs and Blood Institute (NHLBI) tool for case-control studies. Twelve case-control studies which matched the inclusion criteria were included after the literature search. The meta-analysis was carried out using R Studio (version 4.1.3, 2022; The R Foundation for Statistical Computing, Vienna, Austria). The pooled estimate that has been calculated from the salivary LDH course for OSMF was 15.35% and from the serum LDH course for OSMF was 6.82%. There was a visual observation of the funnel's plot asymmetry suggesting publication bias. After adjusting the publication bias, the t2 values for salivary and serum LDH were 41% and 14.71%, respectively, which was less than 50%, indicating that the meta-analysis was statistically significant. The evaluation of salivary and serum LDH can be a useful method for early diagnosis of OSMF as well as OSCC. To infer that individuals may have OPMD or OSCC, specific values for salivary and serum LDH must be found in further investigations.

Exploring Possible Diagnostic Precancerous Biomarkers for Oral Submucous Fibrosis: A Narrative Review

Oral submucous fibrosis (OSF) stands as a progressive oral ailment, designated as a potentially malignant disorder. OSF has gained widespread recognition as a significant precursor to malignant transformation. In the pursuit of dependable, straightforward, and non-invasive diagnostic measures for the early detection of oral malignant progression, research has delved into potential diagnostic biomarkers of OSF. This comprehensive review delves into current investigations that explore the correlation between various biomarkers and OSF. The molecular biomarkers of OSF are categorized based on cytology and sampling methods. Moreover, this review encompasses pertinent studies detailing how these biomarkers are acquired and processed. Within this scope, we scrutinize four potential biomarkers that hold the promise of facilitating the development of diagnostic tools for detecting early-stage OSF.

Estimation of salivary lactate dehydrogenase in oral squamous cell carcinoma, oral leukoplakia, and smokers

Introduction

Lactate dehydrogenase (LDH) is an enzyme seen within every cell during their normal metabolic function. It is always confined within the cell cytoplasm and it becomes extracellular only when a cell dies. The extracellular presence of LDH is related to cell necrosis and tissue breakdown. Therefore, we designed a study to estimate and compare LDH levels in the saliva of patients with oral cancer, oral leukoplakia (OL), and smokers without lesions and in controls.

Materials and Methods

A total of 81 subjects of both genders, between the ages of 20 and 70 years, were included in the study. The study group was divided into four: group I-controls (n = 20), Group II-smokers (n = 20), Group III-subjects with OL (n = 20), and Group IV-subjects with oral squamous cell carcinoma (OSCC) (n = 21). Five milliliters of unstimulated salivary sample was collected from each participant, and salivary LDH level was measured. The obtained values were tabulated and statistically analyzed. P < 0.05 was considered to be statistically significant.

Results

The difference in LDH levels among the four groups was found to "BE" statistically significant. LDH values showed a marked increase in the leukoplakia group (49.79 ± 19.88 IU/L) and OSCC group (106.97 ± 32.75 IU/L) when compared to controls and smokers.

Conclusion

We found that salivary LDH was increased in patients with leukoplakia and OSCC. Smoking alone did not produce any alterations in salivary LDH. It is possible that salivary LDH could be a potential biomarker to identify early premalignant or malignant changes in smokers.

Diagnostic salivary biomarkers in oral cancer and oral potentially malignant disorders and their relationships to risk factors - A systematic review

INTRODUCTION

Oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) are a significant health burden globally. Smoking, alcohol, and betel quid are the main risk factors. Lack of screening methods has been highlighted as a significant challenge in management. Salivary biomarkers are proposed as noninvasive diagnostic tools. The aim of this systematic review was to study salivary biomarkers reported in OSCC and OPMD. Specific objectives were to select a salivary biomarker panel suitable for early detection of OSCC and OPMD and to assess relationships between salivary biomarkers and risk factors.

METHODS

Electronic literature search was conducted in academic databases (Scopus, Medline, Embase and Web of Science) without any restrictions. Following calibration, two blinded reviewers screened the studies and extracted data. A risk of bias assessment was conducted using Newcastle Ottawa scale. 295 studies were included with descriptive data analysis.

EXPERT OPINION

A salivary biomarker panel including Interleukin (IL) 1β, IL6, and IL8 was selected for OSCC and OPMD. Reported relationships between salivary biomarkers and risk factors are discussed and research gaps are highlighted. Future research should be directed to assess potential salivary biomarkers and their relationships to risk factors in order to understand the biomarker's role in disease initiation.

Research Achievements of Oral Submucous Fibrosis: Progress and Prospect

Oral submucous fibrosis (OSMF) is a kind of chronic, insidious disease, and it is categorized into potentially malignant disorders (PMD), which poses a global and regional problem to public health. It is considered to be a multifactorial disease, such as due to areca nut chewing, trace element disorders, and genetic susceptibility. However, there is still no unanimous conclusion on its pathogenesis, diagnosis, and treatment strategies. Hence, this article provides a comprehensive review and prospect of OSMF research, providing scholars and clinicians with a better perspective and new ideas for the research and treatment of OSMF.

A clinicobiochemical evaluation of curcumin as gel and as buccal mucoadhesive patches in the management of oral submucous fibrosis

OBJECTIVE

The objective of this study was to evaluate and compare the efficacy of topical curcumin gel and buccal mucoadhesive patches in the management of oral submucous fibrosis (OSMF).

STUDY DESIGN

Forty patients clinically diagnosed with OSMF were randomly divided into 2 groups. Group A received curcumin gel and group B received curcumin mucoadhesive patches, to be used twice daily for 8 weeks. Evaluation was done every 2 weeks. Serum lactate dehydrogenase (LDH) levels were measured before and after treatment and also in 20 healthy controls.

RESULTS

A 100% reduction in burning sensation was observed in all 40 patients at the end of 4 weeks. Mouth opening improved by 5.45 ± 1.64 mm in group A and 5.9 ± 2.00 mm in group B. Pretreatment LDH was 359.72 ± 77.02 IU/L in patients with OSMF, which was significantly higher than that in healthy volunteers (173.2 ± 46.20 IU/L). In group A, LDH values reduced from 341.85 ± 71 IU/L to 264.95 ± 65.09 IU/L and in group B, values reduced from 377.6 ± 79.76 IU/L to 286.15 ± 72.95 IU/L after treatment.

CONCLUSION

Curcumin gel and mucoadhesive patches were effective in improving mouth opening and reducing burning sensation in patients with OSMF. They can therefore be considered as safe, noninvasive modalities for treatment of OSMF.

Assessment of Lactate Dehydrogenase Levels Among Diabetic Patients Treated in the Outpatient Clinics at King Hussein Medical Center, Royal Medical Services, Jordan

Introduction

Diabetes is a chronic disease and usually is associated with inflammatory conditions. Although assessment of inflammatory markers such lactate dehydrogenase (LDH) is not likely to be conducted in routine practice, it can help in monitoring disease progress.

Aim

The main objectives of the present study are to assess the levels of LDH among diabetic patients treated in the outpatient clinics at King Hussein Medical Center, and to investigate the relationships between the levels of LDH and other variables such as age, gender, BMI, and glucose levels.

Methods

A retrospective study was conducted to collect data from files of diabetic patients. A total of 62 files were selected. Files of diabetic patients were included if complete information including LDH are included. An excel sheet was used to enter the raw data for all patients. The data were analyzed using SPSS version 20. Data were presented as means, standard deviations, frequencies and percentages. The relationships between variables were computed using T test, and Chi-square. The significance will be considered at p ≤ 0.05.

Results

The mean age was 75±12 years. About 53% of participants were males. The mean of BMI was 31.47±20.90 kg/m2. The mean glucose level was 239±85 mg/dl. The mean level of LDH was 328.34±78 U/L. There was a significant association between the level of LDH and study variables. Gender had no significant impacts on the levels of LH and other study variables.

Conclusion

Determination of the level of LDH helps in assessment of progression of diabetes and it is recommended to be performed clinically in routine practice.

Serum and salivary levels of lactate dehydrogenase in oral squamous cell carcinoma, oral lichen planus and oral lichenoid reaction

BACKGROUND

Increased levels of lactate dehydrogenase (LDH) as a tumor marker have been reported in malignant and some premalignant oral lesions such as oral lichen planus (OLP) and oral lichenoid reactions (OLRs). This study aimed to assess the level of total LDH in the saliva and serum of patients with oral squamous cell carcinoma (OSCC), OLP and OLRs.

METHODS

In this case-control study, the participants were divided into four groups (n = 25) of healthy controls, OLP, OLRs, and OSCC. The serum and stimulated/unstimulated salivary levels of LDH were spectrophotometrically measured using standard LDH kits (Pars Azmoun). One-way ANOVA, Chi-square test, Pearson's correlation test, and receiver operating characteristic (ROC) analysis were applied to analyze the data.

RESULTS

The serum and salivary levels of LDH in OSCC patients were significantly higher than that the corresponding values in other groups (P = 0.0001). The serum level of LDH in OLR group was significantly higher than that in the control and OLP groups (P = 0.0001), but the difference in salivary level of LDH was not significant. The ROC analysis showed that both the serum and salivary levels of LDH had significant diagnostic ability for detection of OSCC and OLRs. Significant associations were noted between the serum and salivary levels of LDH.

CONCLUSIONS

Patients with OSCC and OLRs had higher serum levels of LDH than OLP and control groups. Further prospective longitudinal studies are required to assess the tissue level of LDH and monitor the transformation of OLRs because they have low rate of malignant transformation compared with other oral premalignant lesions.

Oral Submucous Fibrosis: A Review on Biomarkers, Pathogenic Mechanisms, and Treatments

Oral submucous fibrosis (OSF) is a collagen deposition disorder that affects a patient’s oral function and quality of life. It may also potentially transform into malignancy. This review summarizes the risk factors, pathogenic mechanisms, and treatments of OSF based on clinical and bio-molecular evidence. Betel nut chewing is a major risk factor that causes OSF in Asia. However, no direct evidence of arecoline-induced carcinogenesis has been found in animal models. Despite identification of numerous biomarkers of OSF lesions and conducting trials with different drug combinations, clinicians still adopt conservative treatments that primarily focus on relieving the symptoms of OSF. Treatments focus on reducing inflammation and improving mouth opening to improve a patient’s quality of life. In conclusion, high-quality clinical studies are needed to aid clinicians in developing and applying molecular biomarkers as well as standard treatment guidelines.

Cellular Prion Protein (PrPc): Putative Interacting Partners and Consequences of the Interaction

Cellular prion protein (PrPc) is a small glycosylphosphatidylinositol (GPI) anchored protein most abundantly found in the outer leaflet of the plasma membrane (PM) in the central nervous system (CNS). PrPc misfolding causes neurodegenerative prion diseases in the CNS. PrPc interacts with a wide range of protein partners because of the intrinsically disordered nature of the protein’s N-terminus. Numerous studies have attempted to decipher the physiological role of the prion protein by searching for proteins which interact with PrPc. Biochemical characteristics and biological functions both appear to be affected by interacting protein partners. The key challenge in identifying a potential interacting partner is to demonstrate that binding to a specific ligand is necessary for cellular physiological function or malfunction. In this review, we have summarized the intracellular and extracellular interacting partners of PrPc and potential consequences of their binding. We also briefly describe prion disease-related mutations at the end of this review.

Salivary LDH in oral cancer and potentially malignant disorders: A systematic review and meta-analysis

OBJECTIVES

To evaluate whether salivary lactate dehydrogenase (LDH) levels are increased in patients with oral cancer (OC) or oral potentially malignant disorders (OPMD) when compared to a healthy control group (CG).

MATERIAL AND METHODS

We conducted a comprehensive search of specialized databases (PubMed/MEDLINE, The Cochrane Library, Web of Science, Scopus, and OpenGrey), including observational analytical studies evaluating the salivary LDH levels (in UI/L or μ/L) in OC or OPMD patients and compared them with a CG.

RESULTS

Thirteen case-control studies were included. A total of 755 patients were evaluated, including 303 OC cases, 149 OPMD cases, and 303 controls. The meta-analysis showed that LDH levels were higher within the OC group than the CG (SMD 9.49; 95% CI 6.97-12; p = .00001). Patients with oral leucoplakia (SMD 11.67; 95% CI 1.01-22.33; p = .03) and oral submucous fibrosis (SMD 25.83; 95% CI -1.74-53.40; p = .07) also presented higher levels than the CG. In addition, OC patients had higher salivary LDH levels than oral leucoplakia patients (SMD 5.62; 95% CI 2.14-9.11; p = .002). Heterogeneity was high across all the evaluated studies.

CONCLUSIONS

The determination of salivary LDH may be a useful method for screening and tracking OC and OPMD, but new protocolized studies are required to establish precise cutoff values.

Assessment of lactate dehydrogenase enzyme levels in saliva and serum of oral submucous fibrosis and leukoplakia patients

Background:

Pathology involving the oral epithelium may alter the level of salivary concentration of LDH. Thus its estimation can be used as a non invasive screening tool for the early detection of OPMDs and also to predict its malignant transformation especially in high risk population.

Aims and Objectives:

To evaluate the salivary and serum levels of lactate dehydrogenase (LDH) in patients having of oral submucous fibrosis (OSMF) and leukoplakia and compare it with healthy individuals.

Materials and Methods:

A total of 120 subjects were selected and divided into three groups comprising clinically diagnosed cases of OSMF and leukoplakia and healthy subjects as controls. Unstimulated whole saliva and blood samples were collected under aseptic conditions for biochemical estimation of LDH by Semiautomatic Analyzer using LDH kit utilizing enzymatic UV-Kinetic method. The values obtained were statistically analyzed using the SPSS software version 20.0. P-value < 0.05 was considered significant.

Results:

The mean salivary LDH level in Group I (OSMF) was 631.67 + 7.67, Group II (Leukoplakia) was 492.28 + 16.17 and Group III (Healthy Control) was 140.62 + 8.87. There was a statistically significant difference between the Serum and salivary LDH levels among the various groups of study population. A positive correlation between salivary LDH and serum LDH level was seen and the regression equation for OSMF and leukoplakia was computed.

Conclusion:

A significant difference was found between mean salivary LDH Levels and serum LDH levels in patients with leukoplakia, OSMF and health controls. A positive correlation was also established between salivary and serum LDH levels in patients with OSMF and leukoplakia patients making saliva a potent non invasive tool for early prediction and detection of PMOD and its malignant transformation.

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

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

Limited mouth opening in oral submucous fibrosis: reasons, ramifications, and remedies

Limited mouth opening (LMO) in oral submucous fibrosis (OSF) has been attributed to both the submucosal and muscle fibrosis (MF). While reflectory trismus was proposed before as an auxiliary mechanism by another group, the stretch-mediated muscle damage (MSD), histopathological changes in blood vessels (such as endothelial dysfunction, endothelial hypertrophy, and endarteritis obliterans), and upregulated anaerobic isoforms of lactate dehydrogenase (LDH) have been proposed by us as complementary events leading to MF. Additionally, the amount of hypoxia-mediated upregulation of anaerobic isoforms of LDH determines the extent of MF. Radiotherapy (RT)-mediated release of reactive oxygen species causes vascular damage thereby worsening hypoxia. While the alteration in LDH levels secondary to hypoxia enhances fibrosis, RT worsens it. Oral squamous cell carcinoma occurring in the background of OSF is an absolute contraindication for RT as it augurs unfavorable prognosis. An algorithm to demonstrate this with evidence is clearly depicted. The role of HIF-1α in the progression of OSF and its malignant transformation, and the consideration of hyperbaric oxygen therapy as a therapeutic remedy in OSF are underscored.

Lactate dehydrogenase as a biomarker in oral cancer and oral submucous fibrosis

BACKGROUND

Oral cancer is the commonest cause of death in the Indian population, with a mortality rate of 0.3 million deaths per year. Oral submucous fibrosis (OSMF) is a potentially malignant disorder that has a high prevalence rate in India. It has been found that serum lactate dehydrogenase levels are increased in potentially malignant and malignant disorders. There are very few data on the application of salivary LDH in the detection of such disorders.

AIMS AND OBJECTIVES

The estimation of LDH levels in saliva as diagnostic markers, using a noninvasive method in patients with OSMF, oral cancer, and in the controls.

METHODS

A total of 60 subjects with the age range of 20-70 years were selected from the Department of Oral Medicine & Radiology and were grouped into three groups. Twenty-five subjects with clinically diagnosed OSMF (Group I), 25 subjects with histopathologically diagnosed oral cancer (Group II), and 10 subjects as control (Group III). Five milliliters of unstimulated whole saliva was aseptically collected. Following which, the collected saliva was centrifuged and then analyzed by ERBA-CHEM 5 semi auto-analyzer. The values obtained were statistically analyzed using descriptive statistics and paired t-test using the SPSS software version 22. P-value < 0.05- was taken as significant.

RESULTS

The mean LDH levels were Group I 608.28 ± 30.22, Group II 630.96 ± 39.80, and Group III 182.21 ± 34.85. The P-value obtained was 0.0009 for both Group I and Group II which was highly significant.

CONCLUSION

Salivary LDH levels were consistently higher in OSMF and oral cancer; hence, it could be a future biomarker.

Equating salivary lactate dehydrogenase (LDH) with LDH-5 expression in patients with oral squamous cell carcinoma: An insight into metabolic reprogramming of cancer cell as a predictor of aggressive phenotype

Oral squamous cell carcinoma (OSCC) is the sixth most common human malignancy. According to World Health Organization, oral cancer has been reported to have the highest morbidity and mortality and a survival rate of approximately 50 % at 5 years from diagnosis. This is attributed to the subjectivity in TNM staging and histological grading which may result in less than optimum treatment outcomes including tumour recurrence. One of the hallmarks of cancer is aerobic glycolysis also known as the Warburg effect. This glycolytic phenotype (hypoxic state) not only confers immortality to cancer cells, but also correlates with the belligerent behaviour of various malignancies and is reflected as an increase in the expression of lactate dehydrogenase 5 (LDH-5), the main isoform of LDH catalysing the conversion of pyruvate to lactate during glycolysis. The diagnostic role of salivary LDH in assessing the metabolic phenotype of oral cancer has not been studied. Since salivary LDH is mainly sourced from oral epithelial cells, any pathological changes in the epithelium should reflect diagnostically in saliva. Thus in our current research, we made an attempt to ascertain the biological behaviour and aggressiveness of OSCC by appraising its metabolic phenotype as indirectly reflected in salivary LDH activity. We found that salivary LDH can be used to assess the aggressiveness of different histological grades of OSCC. For the first time, an evidence of differing metabolic behaviour in similar histologic tumour grade is presented. Taken together, our study examines the inclusion of salivary LDH as potential diagnostic parameter and therapeutic index in OSCC.