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Caponio VCA, Silva FFVE, Popolo F, Giugliano S, Spizzirri F, Lorenzo-Pouso AI, Padín-Iruegas ME, Zhurakivska K, Muzio LL, López-Pintor RM. State of art of micronuclei assay in exfoliative cytology as a clinical biomarker of genetic damage in oral carcinogenesis: A systematic review and meta-analysis. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2024; 794:108508. [PMID: 38964629 DOI: 10.1016/j.mrrev.2024.108508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 04/11/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024]
Abstract
Oral squamous cell carcinoma (OSCC) is the most common oral malignancy, often preceded by oral potentially malignant disorders (OPMDs). Currently, no clinical biomarker exists to predict malignancy, necessitating OPMD follow-up. Habits and environmental factors, such as smoking, and alcohol consumption, influence OSCC onset. Increased micronuclei (MNs) formation has been observed in the development of OSCC. Non-invasive diagnostic tests like exfoliative cytology offer painless and regular monitoring options. This study evaluates the impact of tobacco, alcohol, and pesticide exposure on MNs occurrence in exfoliative cytology-collected oral mucosal cells, assessing their potential as non-invasive biomarker for OSCC development prediction and monitoring in high-risk patients. Despite results from this meta-analysis supporting the existence of a stepwise increase from controls to patients with OPMD to OSCC, the translation of these findings into clinical practice is limited due to intra- and inter-individual heterogeneity, as well as methodological variability in MNs quantification. Various factors contribute to this heterogeneity, including demographic variables, methodological variability of different laboratories, staining techniques, sample collection location, and patient characteristics. All these points were discussed to provide further insights and improve standardization for future studies.
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Affiliation(s)
- Vito Carlo Alberto Caponio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy; ORALMED Research Group, Department of Dental Clinical Specialties, School of Dentistry, Complutense University, Madrid 28040, Spain
| | - Fábio França-Vieira E Silva
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain; ORALRES Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela 15782, Spain.
| | - Francesco Popolo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Sara Giugliano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Francesca Spizzirri
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Alejandro I Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - María Elena Padín-Iruegas
- Human Anatomy and Embryology Area, Department of Functional Biology and Health Sciences, University of Vigo, Vigo 36310, Spain
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71122, Italy
| | - Rosa María López-Pintor
- ORALMED Research Group, Department of Dental Clinical Specialties, School of Dentistry, Complutense University, Madrid 28040, Spain
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Fenech M, Knasmueller S, Nersesyan A, Bolognesi C, Wultsch G, Schunck C, Volpi E, Bonassi S. The buccal micronucleus cytome assay: New horizons for its implementation in human studies. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2024; 894:503724. [PMID: 38432772 DOI: 10.1016/j.mrgentox.2023.503724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 03/05/2024]
Abstract
In this report we provide a summary of the presentations and discussion of the latest knowledge regarding the buccal micronucleus (MN) cytome assay. This information was presented at the HUMN workshop held in Malaga, Spain, in connection with the 2023 European, Environmental Mutagenesis and Genomics conference. The presentations covered the most salient topics relevant to the buccal MN cytome assay including (i) the biology of the buccal mucosa, (ii) its application in human studies relating to DNA damage caused by environmental exposure to genotoxins, (iii) the association of buccal MN with cancer and a wide range of reproductive, metabolic, immunological, neurodegenerative and other age-related diseases, (iv) the impact of nutrition and lifestyle on buccal MN cytome assay biomarkers; (v) its potential for application to studies of DNA damage in children and obesity, and (vi) the growing prospects of enhancing the clinical utility by automated scoring of the buccal MN cytome assay biomarkers by image recognition software developed using artificial intelligence. The most important knowledge gap is the need of prospective studies to test whether the buccal MN cytome assay biomarkers predict health and disease.
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Affiliation(s)
- Michael Fenech
- Genome Health Foundation, North Brighton, SA 5048, Australia.
| | - Siegfried Knasmueller
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
| | - Armen Nersesyan
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claudia Bolognesi
- Environmental Carcinogenesis Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Georg Wultsch
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Emanuela Volpi
- School of Life Sciences, University of Westminster, London, UK
| | - Stefano Bonassi
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, 00166 Rome, Italy.
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Ghelli F, Cocchi E, Buglisi M, Squillacioti G, Bellisario V, Bono R, Santovito A. The role of phase I, phase II, and DNA-repair gene polymorphisms in the damage induced by formaldehyde in pathologists. Sci Rep 2021; 11:10507. [PMID: 34006906 PMCID: PMC8131755 DOI: 10.1038/s41598-021-89833-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/30/2021] [Indexed: 01/16/2023] Open
Abstract
Formaldehyde (FA) is a human carcinogen used as formalin in hospital laboratories. We evaluated its association with human chromosomal aberrations (CAs) and the risk/protective role played by several genetic polymorphisms in this relationship, on a cohort of 57 exposed pathologists vs 48 controls. All subjects were assessed for CAs on peripheral blood lymphocytes and genotyped for the most common cancer-associated gene polymorphisms which could be related with the genotoxic outcome: CYP1A1 exon 7 (A>G), CYP1A1*2A (T>C), CYP2C19*2 (G>A), GSTT1 (Positive/Null), GSTM1 (Positive/null), GSTP1 (A>G), XRCC1 (G399A), XRCC1 (C194T), XRCC1 (A280G), XPD (A751C), XPC exon 15 (A939C), XPC exon 9 (C499T), TNFα - 308 (G>A), IL10 - 1082 (G>A), IL10 - 819 (C>T) and IL6 - 174 (G>C). Air-FA concentration was assessed through personal samplers. The comparison between pathologists and controls showed a significantly higher CAs frequency in pathologists. Significant positive correlations were found between CAs frequency and air-FA concentration while significant associations were found between variation in CAs frequency and the mutated allele for CYP1A1 exon 7 (A>G), CYP2C19*2 (G>A), GSTT1-positive, GSTM1-positive and XRCC1 (G399A). Our study confirms the role of FA as genotoxicity inductor, even in workers chronically exposed to low air-FA levels and reveals the role played by some genetic polymorphisms in this association, highlighting the importance of individual susceptibility biomarkers assessment in occupational health studies.
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Affiliation(s)
- Federica Ghelli
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Enrico Cocchi
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Martina Buglisi
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Valeria Bellisario
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - Alfredo Santovito
- Department of Life Sciences and Systems Biology, University of Turin, Via Accademia Albertina 13, 10123, Turin, Italy
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Vo TTT, Wu CZ, Lee IT. Potential effects of noxious chemical-containing fine particulate matter on oral health through reactive oxygen species-mediated oxidative stress: Promising clues. Biochem Pharmacol 2020; 182:114286. [PMID: 33069666 DOI: 10.1016/j.bcp.2020.114286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
Nowadays, air pollution which is dominated by fine particulate matter with aerodynamic diameter less than or equal to 2.5 µm resulting from rapid industrialization and urbanization combined with population explosion has become more and more severe problem to mankind and the whole planet because of its diversity of deleterious effects. The latest data estimated that exposure to fine particulate matter, or PM2.5, contributes to approximately 4 million deaths worldwide due to cardiopulmonary conditions such as heart disease and stroke, respiratory infections, chronic lung disease and lung cancer. During recent years, there has been growing concern about the adverse effects of this global threat on oral health which is one of key components of general health and quality of life. Although a few studies have reported such possible association, the findings are still far from conclusion. Moreover, the underlying mechanisms remain unclear. To our knowledge, the analysis of literature regarding this scope has yet been published. Thus, current work systematically assesses existing evidences on the potential association between exposure to PM2.5 and the development of various oral diseases as well as figures out the plausible paradigm of PM2.5-induced damages in the oral cavity through its toxic chemical constituents along with its ability to induce oxidative stress via reactive oxygen species production. This might partially provide the clues for new research ideas and progression in the field of oral health.
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Affiliation(s)
- Thi Thuy Tien Vo
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Zong Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Ta Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
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de Geus JL, Wambier LM, Loguercio AD, Reis A. The smokeless tobacco habit and DNA damage: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2019; 24:e145-e155. [PMID: 30818306 PMCID: PMC6441603 DOI: 10.4317/medoral.22846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/01/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this systematic review was to evaluate the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits. MATERIAL AND METHODS We searched PubMed, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE. We also surveyed gray literature. We included only clinical trials that compare the frequency of micronuclei or other DNA damage in the oral mucosa of adults that have smokeless tobacco habits compared to adults that not have these habits. Quality assessments of the selected trials were evaluated by two independent reviewers, using the Effective Public Health Practice Project - (EPHPP) with modifications. RESULTS After the database screening and removal of duplicates, 2574 studies were identified. After title screening, 172 studies remained, and this number was reduced to 25 after careful examination of the abstracts. The standardized mean difference of the frequency of micronuclei between groups was 1.88, with a 95% confidence interval of 1.40 to 2.36 (p < 0.00001). In all analyses heterogeneity was detected. CONCLUSIONS Despite the heterogeneity of studies, the frequency of micronuclei was significant bigger in adults who have the smokeless tobacco habit when compared to those not have this habit. The same occurred with the frequency of binucleated cells, karyolisis and karyorrhexis.
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Affiliation(s)
- J-L de Geus
- Rua Joaquim Sá - Dionísio Torres, Fortaleza, CE, 60135-218, Brasil,
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Nersesyan A. Re: Does smoking habit increase the micronuclei frequency in the oral mucosa of adults compared to non-smokers? A systematic review and meta-analysis. de Geus et al., Clin Oral Investig. 2018 Jan; 22(1):81-91. Clin Oral Investig 2019; 23:497-499. [PMID: 30612240 DOI: 10.1007/s00784-018-2788-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Armen Nersesyan
- Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna, Borschkegasse 8A, 1090, Vienna, Austria.
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Letter to the Editor replying to Armen Nersesyan about the article published in Clinical Oral Investigations tilted "Smoking increases the frequency of micronuclei in the oral mucosa of adults relative to non-smokers-a systematic review and meta-analysis". Clin Oral Investig 2019; 23:503-505. [PMID: 30612245 DOI: 10.1007/s00784-018-2790-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/28/2022]
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Wultsch G, Nersesyan A, Kundi M, Al-Serori H, Knasmüller S. Induction of chromosomal damage in exfoliated buccal and nasal cells of road markers. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:969-976. [PMID: 31596695 DOI: 10.1080/15287394.2019.1673578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Road markers are exposed to various chemicals and particles. The aim of this study was to determine whether road worker exposure induceschromosomal damage which is indicative for increased cancer risks. Micronucleus (MN) cytome assays were thus conducted with exfoliated nasal and buccal cells collected from 42 workers and 42 matched controls. The frequencies of MN (reflecting chromosomal aberrations), nuclear buds (NBuds; reflecting gene amplifications) and binucleated cells (BN; reflecting disturbed mitosis) were scored. Further, the rates of nuclear anomalies indicative of acute cytotoxicity (condensed chromatin, karyorrhexis, karyolysis, pyknosis) were evaluated. Data demonstrated marked induction of MN, NBuds, and BN by 1.34-fold, 1.24-fold and 1.14-fold in buccal cells. In nasal cells, only MN frequencies were elevated, 1.23-fold. These effects were paralleled by increased rates of condensed chromatin, karyorrhexis and karyolysis in both cell types. The effects were more pronounced in individuals who had worked for more than 10 years while smoking did not produce synergistic responses. This is the first investigation concerning the induction of genetic damage in road markers and the results are suggestive for enhanced cancer risks. It is conceivable that exposure to silica dust (known to induce cancer and genetic damage) and/or benzoyl peroxide which forms reactive radicals may be associated with the observed genetic damage in road workers. Further investigations of the cancer risks of these workers are warranted.
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Affiliation(s)
- Georg Wultsch
- Institute of Cancer Research, Medical University of Vienna , Vienna , Austria
| | - Armen Nersesyan
- Institute of Cancer Research, Medical University of Vienna , Vienna , Austria
- Center for Public Health, Medical University of Vienna , Vienna , Austria
| | - Michael Kundi
- Institute of Cancer Research, Medical University of Vienna , Vienna , Austria
| | - Halh Al-Serori
- Institute of Cancer Research, Medical University of Vienna , Vienna , Austria
- Department of Analytical, Environmental and Forensic Sciences, MRC-PHE Centre for Environment and Health, King's College , London , UK
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Upadhyay M, Verma P, Sabharwal R, Subudhi SK, Jatol-Tekade S, Naphade V, Choudhury BK, Sahoo PD. Micronuclei in Exfoliated Cells: A Biomarker of Genotoxicity in Tobacco Users. Niger J Surg 2019; 25:52-59. [PMID: 31007513 PMCID: PMC6452766 DOI: 10.4103/njs.njs_10_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims: The aim of this study was to analyze the tobacco-related genotoxic effects in individual with habit of smoking and chewing tobacco. Materials and Methods: The present study sample consisted of 120 individuals attending the outpatient department of D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh (UP). The sample was divided into four groups as follows: Group I (individuals with habit of smoking tobacco), Group II (individuals with habit of chewing tobacco), Group III (individuals with habit of smoking and chewing tobacco), and Group IV control group (nontobacco-exposed individuals). Patients were asked to rinse their mouth gently with water. The exfoliated cells were obtained by scraping the buccal mucosa of individuals with a wooden spatula. The scraped cells were placed on the precleaned slides. The smears were then stained with RAPID-PAP™ and analyzed under the microscope. Data were analyzed using SPSS statistical software. Results: In the present study, an arbitrary unit was obtained using frequency/day multiplied by the duration of years (risk multiplication factor [RMF], a positive and significant correlation were observed between the RMF and the mean percentage of micronucleated cell count in smokers, chewers, and in individuals with both smoking and chewing habit, respectively. A weak positive and nonsignificant correlation were observed between age and mean percentage of micronucleated cells in smokers and smokers + chewers, respectively, while it was weak negative and nonsignificant in chewers. In control group, correlation between age and percentage of micronucleated cells was weak positive and nonsignificant at 5% level of significance. Conclusion: The micronuclei in exfoliated mucosal cells from buccal mucosa can be used as a biomarker of genotoxicity in predicting the effects of carcinogens.
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Affiliation(s)
- Meenakshi Upadhyay
- Department of Pedodontics and Preventive Dentistry, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Parul Verma
- Department of Conservative Dentistry and Endodontics, IDS, Sehora, Jammu, India
| | - Robin Sabharwal
- Department of Oral Pathology and Microbiology, MMCDSR, Mullana, Ambala, Haryana, India
| | | | - Suruchi Jatol-Tekade
- Department of Orthodontics, Modern Dental College and Research Center, Gandhi Nagar, India
| | - Vihang Naphade
- Department of Oral Medicine and Radiology, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India
| | - Basanta Kumar Choudhury
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Bhubaneswar, Odisha, India
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de Geus JL, Wambier LM, Bortoluzzi MC, Loguercio AD, Kossatz S, Reis A. Does smoking habit increase the micronuclei frequency in the oral mucosa of adults compared to non-smokers? A systematic review and meta-analysis. Clin Oral Investig 2017; 22:81-91. [PMID: 29063385 DOI: 10.1007/s00784-017-2246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/10/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A systematic review of clinical studies to evaluate the frequency of micronuclei in the oral mucosa of smokers and non-smokers in adult patients was performed. MATERIALS AND METHODS A comprehensive search was carried out on MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO, and Cochrane Library and SIGLE without restrictions. Dissertations and thesis were searched using the ProQuest Dissertations and Periodicos Capes Thesis Databases. We included only cross-sectional clinical trials that compared the frequency of micronuclei in the oral mucosa of smokers and non-smokers in adult patients. DATA After the removal of duplicates, 1338 articles were identified. After title and abstract screening, 35 studies remained. Eighteen studies were further excluded, whereas 17 studies remained for qualitative analysis and 16 for the meta-analysis of the primary and secondary outcomes. A significant difference in the frequency of micronuclei in smokers when compared to non-smokers was observed in the present study. CONCLUSIONS Despite the high variation in the methodology of the assessed studies, this study showed a higher frequency of micronuclei in exfoliated cells of smokers compared to non-smokers. CLINICAL SIGNIFICANCE The use of tobacco is associated with cytotoxic and genotoxic effects because a higher frequency of micronuclei in exfoliated cells of smokers was observed.
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Affiliation(s)
| | - Letícia Maíra Wambier
- Department of Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Marcelo Carlos Bortoluzzi
- Department of Stomatology, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Alessandro D Loguercio
- Department of Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Stella Kossatz
- Department of Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Alessandra Reis
- Department of Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil.
- Department of Dentistry, State University of Ponta Grossa, Carlos Cavalcanti street, 4748, Block M., 84030-900, Ponta Grossa, Paraná, Brazil.
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Kohli M, Ahuja P, Mehendiratta M, Sharma M, Dutta J. Micronucleus Assay: An Early Diagnostic Tool to Assess Genotoxic Changes in Patients with Tobacco Use, Oral Leukoplakia and Oral Submucous Fibrosis. J Clin Diagn Res 2017; 11:ZC28-ZC32. [PMID: 29207828 DOI: 10.7860/jcdr/2017/27711.10567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022]
Abstract
Introduction Micronuclei (MNi) are acentric chromatid or chromosome fragments produced via genetic damage through genotoxic agents contained in tobacco and betel nut. Evidently, the various Oral Potentially Malignant Disorders (OPMDs) like oral lichen Planus, oral leukoplakia and Oral Submucous Fibrosis (OSMF) demonstrate MNi, as a substantiation of genetic damage. As these changes can be easily appreciated in oral exfoliated cells, an exfoliated cell based MNi assay might be utilized as handy and non invasive biomonitoring tool for gauging the genetic damage and hence the propensity for malignant transformation in OPMDs. To this end, MNi are definitely easier to evaluate when compared to chromosome aberrations. Aim To compare the MNi frequency in normal mucosa, in individuals using various tobacco forms without oral leukoplakia, individuals using various tobacco forms with oral leukoplakia, and areca nut chewers with OSMF, using three different stains. Materials and Methods Oral exfoliated cells from 50 cases of normal mucosa (Group I), 50 cases of tobacco chewing people without Oral Leukoplakia (Group II), 50 cases of people with Oral Leukoplakia (Group III) and 50 cases of areca nut chewers with OSMF (Group IV) were taken. MNi frequencies were compared in these groups using three different stains i.e., Papanicolaou (PAP) stain, May Grunwald Giemsa (MGG) stain and Feulgen stain. The data between cases (Group II, III and IV) and control groups (Group I) was analyzed by Kruskal-Wallis Test. The comparison between two independent groups was done by Mann-Whitney U test and interstain comparison between cases and control was done by Wilcoxon Signed Rank Test and the individual p-value was obtained. Results A significant increase in the count was observed during transition of normal mucosa to OPMDs. The best stain for detecting MNi was PAP stain followed by MGG stain and Feulgen stain. Conclusion The higher mean MNi count for PAP stain and MGG stain could be attributed to nonspecific staining. Further study using a larger sample size on quantitative assessment of MNi count in various OPMDs is warranted.
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Affiliation(s)
- Moulshree Kohli
- Senior Lecturer, Department of Oral Pathology, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Puneet Ahuja
- Principal, Professor and Head, Department of Oral Pathology, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Monica Mehendiratta
- Reader, Department of Oral Pathology, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Mohit Sharma
- Reader, Department of Oral Pathology, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Jahnobi Dutta
- Medical Research Scientist, Jorhat Medical College and Hospital, Barbheta, Jorhat, Assam, India
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Rana SVS, Verma Y, Singh GD. Assessment of genotoxicity amongst smokers, alcoholics, and tobacco chewers of North India using micronucleus assay and urinary 8-hydroxyl-2'-deoxyguanosine, as biomarkers. ENVIRONMENTAL MONITORING AND ASSESSMENT 2017; 189:391. [PMID: 28702879 DOI: 10.1007/s10661-017-6103-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/23/2017] [Indexed: 06/07/2023]
Abstract
The main objective of the present study was to screen the genotoxicity caused by individual and combined habits of smoking, tobacco chewing, and alcohol consumption in human population of North India. Study recruited 67 male subjects aged 25 to 65 years. Buccal mucosal cells were subjected to micronucleus (MN) assay, and 8-hydroxyl-2-deoxyguanosine (8-OHdG) was estimated in their urine samples. Number and shape of the MN cells varied in the buccal epithelium of different groups. Maximum number of MN (0.47%) were found in tobacco chewers followed by smokers (0.45%) and alcoholics (0.44%) (P < 0.05). These results reciprocated the concentration of urinary 8-OHdG. Maximum value for 8-OHdG was also recorded in tobacco chewers (21.07 ± 5.51 mg/mg creatinine) followed by smokers (20.25 ± 3.96 mg/mg creatinine) and alcoholics (19.06 ± 3.41 mg/mg creatinine) (P < 0.05). Combined effects of these agents were found to be statistically different from individual effects. Carcinogenic compounds present in cigarette smoke, nitrosamines found in solid tobacco, and acetaldehyde, a metabolic product of alcohol, induce oxidative stress that manifests into genotoxicity. In conclusion, demographical differences occur in the genotoxicity caused by these three habits. MN assay and urinary 8-OHdG are simple, noninvasive, and reliable biomarkers of genotoxicity.
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Affiliation(s)
- S V S Rana
- Department of Zoology, Toxicology Laboratory, Ch. Charan Singh University, Meerut, UP, 250004, India.
| | - Yeshvandra Verma
- Department of Zoology, Toxicology Laboratory, Ch. Charan Singh University, Meerut, UP, 250004, India
| | - Gagan Deep Singh
- Department of Zoology, Toxicology Laboratory, Ch. Charan Singh University, Meerut, UP, 250004, India
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Lorenzoni DC, Pinheiro LP, Nascimento HS, Menegardo CS, Silva RG, Bautz WG, Henriques JF, Almeida-Coburn KL, da Gama-de-Souza LN. Could formaldehyde induce mutagenic and cytotoxic effects in buccal epithelial cells during anatomy classes? Med Oral Patol Oral Cir Bucal 2017; 22:e58-e63. [PMID: 27918743 PMCID: PMC5217497 DOI: 10.4317/medoral.21492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/16/2016] [Indexed: 01/23/2023] Open
Abstract
Background Due to increased formaldehyde exposure, carcinogenic to humans, several researches have been studying the potential toxicity and the safe levels for human beings. The aim of this study was to investigate mutagenicity and cytotoxicity in buccal epithelial exfoliated cells (BEC) of students subjected to formaldehyde (FA) during anatomy classes. Material and Methods BEC were collected periodically from 17 volunteers of undergraduate programs, who had participated in practical anatomy classes, before and after FA exposure. Cells were stained according to Feulgen method and then micronucleus test was applied. A total of 1,500 cells were assessed per individual in this study for the micronucleus frequency and other parameters of cytotoxicity. Results There was statistically significant increase in number of micronucleated BEC after FA exposure (after 1 month p=.034 and after 3.5 months p=.017). However, FA exposure caused no significant increase in other nuclear alterations closely related to cytotoxicity (p≥.05). Conclusions FA induced mutagenicity during anatomy classes. Cell death increased, but it was not statistically significant. Efforts have to be made to improve air quality and reduce exposures during anatomy classes. Key words:Carcinogens, formaldehyde, micronucleus tests, mutagenicity tests.
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Affiliation(s)
- D-C Lorenzoni
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, 17012-901, Brazil.
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Sabharwal R, Verma P, Syed MA, Sharma T, Subudhi SK, Mohanty S, Gupta S. Emergence of micronuclei as a genomic biomarker. Indian J Med Paediatr Oncol 2016; 36:212-8. [PMID: 26811590 PMCID: PMC4711219 DOI: 10.4103/0971-5851.171541] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The presence of micronuclei (MN) in mammalian cells is related to several mutagenetic stresses. MN are formed as a result of chromosome damage and can be readily identified in exfoliated epithelial cells. MN is chromatin particles derived from acentric chromosomal fragments, which are not incorporated into the daughter nucleus after mitosis. It can be visualized by chromatin stains. A variety of factors influences the formation of MN in cells such as age, sex, genetic constitution, physical and chemical agents, adverse habits such as tobacco, areca nut chewing, smoking, and alcohol consumption. Micronucleation has important implications in the genomic plasticity of tumor cells. The present paper reviews the origin, fate and scoring criteria of MN that serves as a biomarker of exposure to genetic toxins, and for the risk of cancer.
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Affiliation(s)
- Robin Sabharwal
- Department of Oral and Maxillofacial Pathology, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
| | - Parul Verma
- Department of Endodontics, Himachal Dental College, Sundernagar, Himachal Pradesh, India
| | - Mohammed Asif Syed
- Department of Oral Medicine and Radiology, Darshan Dental College & Hospital, Udaipur, India
| | - Tamanna Sharma
- Department of Oral Pathology and Microbiology, Himachal Dental College, Sundernagar, Himachal Pradesh, India
| | - Santosh Kumar Subudhi
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bhubneshwar, India
| | | | - Shivangi Gupta
- Department of Periodontics, DJ College of Dental Sciences and Research, Uttar Pradesh, India
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15
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Safi Oz Z, Doğan Gun B, Ozdamar SO. Why an Experienced Eye May Not Detect Micronucleated Cells Using Papanicolaou's Stain. Acta Cytol 2015; 59:431-3. [PMID: 26658559 DOI: 10.1159/000440934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
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Srivastava VK, Gara RK, Rastogi N, Mishra DP, Ahmed MK, Gupta S, Goel MM, Bhatt MLB. Serum vascular endothelial growth factor-A (VEGF-A) as a biomarker in squamous cell carcinoma of head and neck patients undergoing chemoradiotherapy. Asian Pac J Cancer Prev 2015; 15:3261-5. [PMID: 24815480 DOI: 10.7314/apjcp.2014.15.7.3261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate serum VEGF-A levels in squamous cell carcinoma of head and neck (SCCHN) patients and relationships with response to therapy. MATERIALS AND METHODS Serum VEGF-A levels in patients (n=72) treated with radiotherapy (RT) or radio-chemotherapy (RCT) and controls (n=40) were measured by ELISA. RESULTS Serum VEGF-A levels of the SCCHN cases were significantly higher (p=0.001) than in healthy controls, and in patients with positive as compared to negative lymph node status (p=0.004). Similarly, patients with advanced stage (Stage III-IV) disease had more greatly elevated levels of serum VEGF-A level than their early stage (Stage I-II) counterparts (p=0.001). In contrast, there was no significant difference (p=0.57) in serum level of VEGF-A in patients with advanced T-stage (T3-4) as compared to early stage (T1-2). Similarly, patients with distant metastasis had no significant (p=0.067) elevation in serum VEGF-A level as compared to non-metastatic disease. However, the non-responder patients had significantly higher serum VEGF-A level as compared to responders (p=0.001). CONCLUSIONS Our results suggest that the serum VEGF-A level may be a useful biomarker for the prediction of response to therapy in SCCHN.
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Affiliation(s)
- Vikas Kumar Srivastava
- Department of Radiotherapy, King George's Medical University, Uttar Pradesh, India E-mail :
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17
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Kalaev VN, Artyukhov VG, Nechaeva MS. Micronucleus test of human oral cavity buccal epithelium: Problems, achievement, perspectives. CYTOL GENET+ 2014. [DOI: 10.3103/s0095452714060061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Jessie K, Jayapalan JJ, Rahim ZHA, Hashim OH. Aberrant proteins featured in the saliva of habitual betel quid chewers: An indication of early oral premalignancy? Electrophoresis 2014; 35:3504-11. [DOI: 10.1002/elps.201400252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Kala Jessie
- Department of Oral Biology and Biomedical Sciences; Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | - Jaime Jacqueline Jayapalan
- University of Malaya Centre for Proteomics Research; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Zubaidah Haji Abdul Rahim
- Department of Oral Biology and Biomedical Sciences; Faculty of Dentistry; University of Malaya; Kuala Lumpur Malaysia
| | - Onn Haji Hashim
- University of Malaya Centre for Proteomics Research; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
- Department of Molecular Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
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Katarkar A, Mukherjee S, Khan MH, Ray JG, Chaudhuri K. Comparative evaluation of genotoxicity by micronucleus assay in the buccal mucosa over comet assay in peripheral blood in oral precancer and cancer patients. Mutagenesis 2014; 29:325-334. [DOI: 10.1093/mutage/geu023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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20
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Mr P, Guruprasad Y, Jose M, Saxena K, K D, Prabhu V. Comparative Study of Genotoxicity in Different Tobacco Related Habits using Micronucleus Assay in Exfoliated Buccal Epithelial Cells. J Clin Diagn Res 2014; 8:ZC21-4. [PMID: 24995238 DOI: 10.7860/jcdr/2014/8733.4357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/11/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oral cancer is one of the most debilitating diseases afflicting mankind. Consumption of tobacco in various forms constitutes one of the most important etiological factors in initiation of oral cancer. When the focus of today's research is to determine early genotoxic changes in human cells, micronucleus (MN) assay provides a simple, yet reliable indicator of genotoxic damage. AIMS AND OBJECTIVES To identify and quantify micronuclei in the exfoliated cells of oral mucosa in individuals with different tobacco related habits and control group, to compare the genotoxicity of different tobacco related habits between each group and also with that of control group. PATIENTS AND METHODS In the present study buccal smears of 135 individuals with different tobacco related habits & buccal smears of 45 age and sex matched controls were obtained, stained using Giemsa stain and then observed under 100X magnification in order to identify and quantify micronuclei in the exfoliated cells of oral mucosa. RESULTS The mean Micronucleus (MN) count in individuals having smoking habit were 3.11 while the count was 0.50, 2.13, and 1.67 in normal control, smoking with beetle quid and smokeless tobacco habit respectively. MN count in smokers group was 2.6 times more compared to normal controls. MN count was more even in other groups when compared to normal control but to a lesser extent. CONCLUSION From our study we concluded that tobacco in any form is genotoxic especially smokers are of higher risk and micronucleus assay can be used as a simple yet reliable marker for genotoxic evaluation.
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Affiliation(s)
- Pradeep Mr
- Senior Lecturer, Department of Oral Pathology & Microbiology, AME'S Dental College, Hospital and Research Institute , Raichur, Karnataka, India
| | - Yadavalli Guruprasad
- Reader, Department of Oral Pathology & Microbiology, AME'S Dental College, Hospital and Research Institute , Raichur, Karnataka, India
| | - Maji Jose
- Professor and Head, Department of Oral Pathology & Microbiology, Yenepoya Dental College and Hospital , Mangalore, Karnataka, India
| | - Kartikay Saxena
- Senior Lecturer, Department of Oral Pathology & Microbiology, Yenepoya Dental College and Hospital , Mangalore, Karnataka, India
| | - Deepa K
- Senior Lecturer, Department of Oral Pathology & Microbiology, AME'S Dental College, Hospital and Research Institute , Raichur, Karnataka, India
| | - Vishnudas Prabhu
- Professor, Department of Oral Pathology & Microbiology, Yenepoya Dental College and Hospital , Mangalore, Karnataka, India
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Anass MA, G Ahmed H. A Case-Control Study of Oral Epithelial Proliferative Markers among Sudanese Toombak Dippers Using Micronuclei Assay, Argyrophilic Nucleolar Organizer Region, Papanicolaou and Crystal Violet Methods. Rare Tumors 2013; 5:e31. [PMID: 24179643 PMCID: PMC3804806 DOI: 10.4081/rt.2013.e31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/22/2013] [Accepted: 03/12/2013] [Indexed: 11/23/2022] Open
Abstract
The use of Toombak has been reported to play a major role in the etiology of oral cancer in Sudan. The cellular proliferative activity on the oral epithelium of 210 Toombak dippers was assessed by applying the micronuclei frequency, mean argyrophilic nucleolar organizer region (AgNOR) counts, Papanicolaou method, and 1% crystal violet stain. Participants were divided into 3 groups: 200 were apparently healthy individuals, 100 were Toombak users (cases), 100 were non-tobacco users (control) and 10 were patients with oral squamous cell carcinomas. Cytological atypia was identified among 4 (4%). Toombak users and was not found among the control group (P<0.04). The micronuclei frequencies were higher in Toombak users (1.026) than in the control group (0.356) (P<0.0001). The mean AgNOR counts in Toombak users (2.423) were higher than control group (1.303) (P<0.0001). Neither Toombak users nor control group showed mitotic figures in 1% crystal violet method. The results of this research showed that Toombak dipping is a high risk factor for increase in the cellular proliferation in the oral mucosa. The cytological proliferative marker methods used are useful for screening Toombak users.
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Jyoti S, Khan S, Afzal M, Naz F, Siddique YH. Evaluation of micronucleus frequency by acridine orange fluorescent staining in bucccal epithelial cells of oral submucosus fibrosis (OSMF) patients. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2013. [DOI: 10.1016/j.ejmhg.2012.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Tobacco chewing is a widespread habit which leads to DNA damage. We are reporting a case of a tobacco chewer in which chromosomal aberrations, DNA breakage, buccal micronuclei and urinary thioether excretion level were studied. The study was carried out on a 28 year old male subject who is polio affected since his childhood. He has been chewing tobacco since the last 17 yrs @ 4 g, 08 times per day. The medical report of the subject indicates no abnormalities except post-polio paralysis in both lower limbs. He has no family history of any genetic disorder. He is not occupationally exposed to tobacco. The findings of the present investigation indicate increased incidence of chromosomal aberration % and micronuclei in buccal epithelial cells than the control values obtained from a subject of similar age and socioeconomic condition but not addicted to tobacco chewing. However, the urinary thioether values of the subject were lower than control values indicating a depression of the detoxification pathway.
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Affiliation(s)
- Asha Khanna
- Department of Zoology and Biotechnology, St. Aloysius College (Autonomous), Jabalpur, Madhya Pradesh, India
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24
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Lorenzoni DC, Fracalossi ACC, Carlin V, Ribeiro DA, Sant'anna EF. Mutagenicity and cytotoxicity in patients submitted to ionizing radiation. Angle Orthod 2012; 83:104-9. [PMID: 22656641 DOI: 10.2319/013112-88.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate and compare mutagenicity (micronucleus) and cytotoxicity (karyorrhexis, pyknosis, and karyolysis) in exfoliated buccal mucosa cells of children following cone beam computed tomography (CBCT) or conventional radiograph exposure necessary for orthodontic planning. MATERIALS AND METHODS A total of 49 healthy children were submitted to CBCT or a conventional orthodontic radiographic protocol; they were divided into two groups based on exam: CBCT (n = 24) and Radiographic Set (n = 25) groups. The micronucleus test in the exfoliated buccal mucosa cells was applied. RESULTS There was not a statistically significant difference (P > .05) found between the number of micronucleated buccal mucosa cells (MNC) before and after exposure to radiation in either group, showing that neither group experienced a mutagenic effect. However, radiation did cause other nuclear alterations closely related to cytotoxicity, including karyorrhexis, pyknosis, and karyolysis, in both groups (P < .05). The CBCT group presented a greater increase in cell death than was noted in the Radiographic Set group (P < .044). CONCLUSION According to the micronucleus test, mutagenicity was not induced by the CBCT or the conventional radiographs, but cytotoxicity was verified after these exams, especially after CBCT. That might have happened once the CBCT group received a greater radiation dose than the Radiographic Set group as a result of the protocols used in orthodontic planning for this study.
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Affiliation(s)
- Diego Coelho Lorenzoni
- Department of Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Ghani WMN, Razak IA, Yang YH, Talib NA, Ikeda N, Axell T, Gupta PC, Handa Y, Abdullah N, Zain RB. Factors affecting commencement and cessation of betel quid chewing behaviour in Malaysian adults. BMC Public Health 2011; 11:82. [PMID: 21294919 PMCID: PMC3039591 DOI: 10.1186/1471-2458-11-82] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/07/2011] [Indexed: 11/23/2022] Open
Abstract
Background Betel quid chewing is a common habit widely practiced in Southern Asian populations. However, variations are seen in the content of a betel quid across the different countries. Factors associated with commencement and cessation of this habit has been numerously studied. Unfortunately, data on Malaysian population is non-existent. This study aims to determine the factors associated with the inception and also cessation of betel quid chewing behaviour among Malaysian adults. Method This study is part of a nationwide survey on oral mucosal lesions carried out among 11,697 adults in all fourteen states in Malaysia. The questionnaire included sociodemographic information and details on betel quid chewing habit such as duration, type and frequency. The Kaplan-Meier estimates were calculated and plotted to compare the rates for the commencement and cessation of betel quid chewing behaviour. Cox proportional hazard regression models were used to calculate the hazard rate ratios for factors related to commencement or cessation of this habit. Results Of the total subjects, 8.2% were found to be betel quid chewers. This habit was more prevalent among females and, in terms of ethnicity, among the Indians and the Indigenous people of Sabah and Sarawak. Cessation of this habit was more commonly seen among males and the Chinese. Females were found to be significantly more likely to start (p < 0.0001) and less likely to stop the quid chewing habit. Females, those over 40 years old, Indians and a history of smoking was found to significantly increase the likelihood of developing a quid chewing habit (p < 0.0001). However, those who had stopped smoking were found to be significantly more likely to promote stopping the habit (p = 0.0064). Cessation was also more likely to be seen among those who chewed less than 5 quids per day (p < 0.05) and less likely to be seen among those who included areca nut and tobacco in their quid (p < 0.0001). Conclusion Factors that influence the development and cessation of this behaviour are gender, age, ethnicity, and also history of smoking habit while frequency and type of quid chewed are important factors for cessation of this habit.
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Affiliation(s)
- Wan M N Ghani
- Oral Cancer Research & Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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