Oxidant-antioxidant status in blood and tumor tissue of oral squamous cell carcinoma patients

Assessment of Antioxidant Enzyme Superoxide Dismutase (SOD) in Oral Cancer: Systematic Review and Meta-Analysis

Objective

The present article aims to comprehensively review the existing literature on superoxide dismutase (SOD) levels, an antioxidant enzyme, in oral cancer.

Method

An extensive literature search was conducted across various databases, including PubMed, Wiley Online Library, Science Direct, and Cross Reference, spanning 1998-2023. At the outset, 1,177 articles were initially identified, and 907 studies were excluded due to irrelevance or duplication of the research question. Subsequently, 270 articles underwent screening evaluation, resulting in the selection of 85 articles meeting the inclusion criteria. Following this, 68 articles underwent a full-text comprehensive assessment, and ultimately, 39 were chosen for data extraction. The risk of bias in the designated articles was assessed using the Newcastle-Ottawa Scale. Finally, 13 studies were meticulously selected, offering consistent data for the ensuing meta-analysis. Meta-analysis was executed using comprehensive meta-analysis (CMA) version 3 software (Bio Stat Inc., Englewood, NJ, USA). The meta-analysis findings revealed a statistically significant decrease in SOD levels in both erythrocyte samples (P < 0.001) and tissue samples (P < 0.05) among individuals with oral cancer (OSCC) compared to the normal control group. Conversely, the analysis of three studies on salivary samples demonstrated a significant increase (P < 0.05) in SOD levels in the oral cancer group compared to the healthy controls.

Conclusion

This systematic review underscores a statistically significant decline in SOD levels observed across diverse bio-samples in individuals with oral cancer, indicating an excess of oxidative stress (OS). Additional research is needed to delve into the relationship between SOD levels and clinic-pathological prognostic markers within the oral cancer cohort. Such investigations have the potential to significantly contribute to the development of prognostic tools grounded in OS, thereby guiding strategies for treatment planning.

New insights into redox-related risk factors and therapeutic targets in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most common cancer in the oral cavity accounting for 90 % of oral cancer with a global incidence of 350.000 new cases per year. Curative resection along with adjuvant radiation therapy or a combination of radiotherapy with chemotherapy remain as gold standard in treating OSCC. Still, local recurrence, lymph nodal recurrence, and complications of radiation remain the main cause of tumor-related mortality. Reactive oxygen species are not only correlated to the etiology of OSCC due to oxidative DNA damage, lipid peroxidation or effecting signal transduction cascades that effect cell proliferation and tumorigenesis, but are also of great interest in the therapy of OSCC patients. As induced oxidative stress can be used therapeutically for the induction of tumor cell death, redox targets might be a therapeutic addition to the conventional treatment options. In this review, we discuss markers of impaired redox homeostasis as well as potential redox-related treatment targets in OSCC.

Assessment of glutathione peroxidase enzyme response and total antioxidant status in oral cancer - Systematic review and meta-analysis

BACKGROUND

Oxidative stress induced by free radical accumulation contributes to many pathologies, including cancer. Antioxidant defense system fails to scavenge free radicals when it is excessively accumulated. Assessing individual antioxidant enzymes and total antioxidant capacity could direct the customized therapeutic strategies.

OBJECTIVE

Evaluation of total antioxidant status and enzyme glutathione peroxidase activity in the oral cancer group compared to the healthy control group.

METHOD

The literature search included databases PubMed, Science Direct, Wiley Online Library, Cochrane and Cross Reference between 1999 and 2021. The database search was completed in the month of August 2022. The extracted data were analyzed by Comprehensive Meta-Analysis (CMA) version 3 software (Biostat Inc. Englewood, NJ). Based on search strategies, 1435 articles have been retrieved from the database. In the segregated articles, 1365 were excluded due to duplicated articles, animal studies, low-quality studies, articles unrelated to the research question, and with unmatched objectives. Based on inclusion criteria, 70 articles were selected for full-text valuation. However, 33 articles were found highly suitable for inclusion and data extraction. Finally, 11 articles were selected for meta-analysis.

RESULTS

The meta-analysis of four included studies of tissue samples showed a significantly (p < .001) increased GPx activity in the oral cancer group, when compared to the control group, whereas three included studies of erythrocyte samples displayed a significantly (p < .001) decreased GPx activity in the oral cancer group than the control group with the pooled standardized mean difference value of -2.766 moles/min/g Hb at 95% CI (-3.297 to -2.234). The meta-analysis of the included studies depicted an insignificant (p = .947) reduction of salivary TAS levels in the oral cancer group when compared to the control group.

CONCLUSION

Our systematic review and meta-analysis depict antioxidant GPx enzyme activity in the regional tissue samples of the oral cancer group differs from other systemic biological fluid samples compared to the healthy control group.

Depleting levels of endogenous anti-oxidant superoxide dismutase in oral sub-mucous fibrosis: A systematic review and meta-analysis

Objective

The systematic review is aimed to assess the antioxidant status by superoxide dismutase level in oral sub-mucous fibrosis using available literature.

Materials and methods

A literature search was accomplished electronically in Pubmed (MeSH), Science Direct, Scopus, Web of Science core collection, Cochrane, and Cross-reference, using the keywords such as 'oral submucous fibrosis,' 'antioxidant status' and 'superoxide dismutase.'

Results

Of the 352 articles identified, only 16 satisfied the selection criteria and were included in the systematic review. Among the selected, six studies were included for serum level analysis of superoxide dismutase. The assessment showed a significant reduction of serum superoxide dismutase in oral submucous fibrosis patients than in control (p < 0.004). The mean difference in serum superoxide dismutase concentration between oral submucous fibrosis and healthy subjects was -86.23 U/ml (95% CI -145.30, -27.17). The serum SOD level was significantly reduced as the disease progressed to stage I or stage II (p < 0.001) compared to the control group.

Conclusion

The studies showed significantly lower levels of superoxide dismutase in various human samples of patients with OSMF. Therefore, further studies are required to estimate antioxidant status using different biomarkers of oral submucous fibrosis concerning different stages of the disease in order to augment future therapy.

Clinical relevance

Assessment of antioxidant activity helps to identify the patients at risk of malignant transformation. It serves as a reliable guide to validate therapy. It serves as a marker of prognosis in patients suffering from oral submucous fibrosis.

Epigallocatechin gallate enhances human lens epithelial cell survival after UVB irradiation via the mitochondrial signaling pathway

The aim of the present study was to explore the mechanism underlying the ultraviolet B (UVB) irradiation-induced apoptosis of human lens epithelial cells (HLECs), and to investigate the protective effect of epigallocatechin gallate (EGCG) against the UVB-induced apoptosis of HLECs. HLECs were exposed to different concentrations of EGCG plus UVB (30 mJ/cm²). Cell viability was determined using the MTT assay. Furthermore, mitochondrial membrane potential (Δψm) and apoptosis were assessed by flow cytometry with JC-1 and Annexin V/PI staining, respectively. Moreover, the activities of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), as well as the levels of GSH, hydrogen peroxide (H₂O₂) and hydroxyl free radicals were determined using biochemical assay techniques. Reverse transcription-quantitative PCR and western blotting were used to detect the mRNA and protein expression levels of Bcl-2, Bax, cytochrome c, caspase-9 and caspase-3, respectively. The results revealed that UVB irradiation reduced the Δψm of HLECs and induced apoptosis. Notably, EGCG significantly attenuated the generation of H₂O₂ and hydroxyl free radicals caused by UVB irradiation in HLECs, and significantly increased CAT, SOD and GSH-Px activities, however, the GSH levels were not significantly increased. EGCG also reduced UVB-stimulated Bax, cytochrome c, caspase-9 and caspase-3 expression, and elevated Bcl-2 expression, suggesting that EGCG may possess free radical-scavenging properties, thus increasing cell viability. In conclusion, EGCG may be able to protect against UVB-induced HLECs apoptosis through the mitochondria-mediated apoptotic signaling pathway, indicating its potential application in clinical practice.

Malondialdehyde, an Oxidative Stress Marker in Oral Squamous Cell Carcinoma-A Systematic Review and Meta-Analysis

Objective: To qualitative and quantitatively review published literature assessing the oxidative stress marker malondialdehyde (MDA) in oral squamous cell carcinoma (OSCC). Methodology: Pubmed (MeSH), Science Direct, Scopus, Web of Science, Willey Online Library, Cochrane, and Cross Reference were searched for studies assessing MDA levels in OSCC samples. Results: From the 1008 articles identified, 849 were excluded based on title and abstract screening due to duplication and irrelevance to the topic of interest. Full-text assessment of the remaining 159 articles led to the inclusion of only 46 articles that satisfied the selection criteria. Of these, only 26 studies had data compatible for quantitative analysis. The MDA levels in OSCC groups are significantly increased (p < 0.00001) in plasma, serum, and saliva samples in the majority of the studies evaluated. In contrast, MDA levels in OSCC tissue samples are significantly attenuated (p < 0.00001) compared to healthy controls, supported by fewer studies. Conclusions: The augmented MDA levels in plasma, serum, and saliva samples of the OSCC reflect the heightened oxidative stress level accurately. Further studies are required to understand the attenuated MDA levels in the tissue samples of OSCC. Correlation analysis between MDA levels with established clinicopathological prognostic markers could aid in formulating oxidative stress-based prognostication and treatment planning.

A Meta-Analysis in Assessing Oxidative Stress Using Malondialdehyde in Oral Submucous Fibrosis

Objective This study aimed to evaluate the oxidative stress (OS) marker Malondialdehyde (MDA) in oral submucous fibrosis with available literature.

Materials and Methods We conducted a literature search electronically in PubMed (MeSH), Science Direct, Scopus, and Google Scholar using specific keywords.

Results A systematic search in PubMed, Science Direct, and Google Scholar identified 334 articles. Of these, four were duplicate reports, and three were animal studies. After reading the abstracts of the collected articles, 288 articles were excluded for the following reasons: low quality, not relevant to the research question, or did not meet the inclusion criteria. The remaining 46 articles were chosen for full-text assessment. Finally, the present qualitative synthesis included 23 articles for evaluation. The selected studies in MDA analysis in a random-effects model showed higher heterogeneity (Q = 477.636, p < 0.001, I ² = 95.394%). The standard difference in mean MDA concentration between oral submucous fibrosis (OSMF) and healthy subjects was estimated as 2.73 nmol/mL (95% confidence interval: 2.08–3.38).

Conclusion The selected studies showed significantly higher MDA levels in various biological samples of patients with OSMF. Therefore, further studies are needed to estimate oxidative stress levels by using different biomarkers in OSMF to direct future therapy.

Radioprotective effect of radiation-induced Lactococcus lactis cell-free extract against 60Coγ injury in mice

Ionizing radiation (IR) is widely used in the diagnosis and treatment of various cancers. However, IR can cause damage to human health by producing reactive oxygen species. Lactococcus lactis is a type of microorganism that is beneficial to human health and has a strong antioxidant capacity. In this study, the protective effect of normal and IR-induced L. lactis IL1403 cell-free extracts (CFE and IR-CFE, respectively) against oxidative damage in vitro and the radioprotective effect of IR-CFE in vivo was evaluated using ⁶⁰Coγ-induced oxidative damage model in mice. Results showed that IR-CFE exhibited a stronger oxidative damage-protective effect than CFE for L. lactis IL1403 under H₂O₂ in vitro. Moreover, IR-CFE also showed strong radioprotective effect on hepatocyte cells (AML-12) under radiation condition, and the effect was better than that of CFE. Animal experiment indicated that IR-CFE could reduce the IR-induced damage to the hematopoietic system by increasing the number of white blood cells and red blood cells in peripheral blood of irradiated mice. It was also observed that IR-CFE could markedly alleviate the ⁶⁰Coγ-induced oxidative stress via increasing the activities of superoxide dismutase and glutathione peroxidase, enhancing the levels of glutathione, and decreasing the contents of malondialdehyde in serum, liver, and spleen. In addition, IR-CFE also could reduce the activities of alanine transaminase and aspartate aminotransferase in serum, thereby reducing radiation damage to the liver. These results suggested that IR-CFE could be considered as potential candidates for natural radioprotective agents. This study provides a theoretical basis for improving the application of lactic acid bacteria.

Are the oxidative stress levels in the tumor center and tumor boundary different from those in healthy tissue?

PURPOSE

This study aimed to investigate the relationship between oxidative stress levels in the tumor center, tumor edge, and healthy tissue.

METHODS

This study included a total of 53 patients with head and neck cancer. Samples of 5 × 5 × 5 mm were collected from the tumor center, tumor edge, and the healthy tissue. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were evaluated. (1) Oxidative stress values in the center and edge of all tumors and in healthy tissues were compared according to localization. (2) Tumors were divided into two groups as malignant (Group 1 [n = 28]: Laryngeal and tongue squamous cell cancers) and benign (Group 2 [n = 25]: Pleomorphic adenoma and Warthin tumors). The groups were compared according to the localization of the tissues.

RESULTS

The TOS value in the tumor edge was significantly higher than those in the tumor center and the healthy tissue. The TAS value in tissue located in the tumor edge was significantly higher than in the healthy tissue. The OSI value in the tumor edge was significantly higher than those in the tumor center and the healthy tissue. In all three localizations (tumor center, tumor edge, and healthy tissue), TOS and OSI values in Group 1 were significantly higher than Group 2.

CONCLUSION

Oxidative stress values in the tumor edge are significantly higher than the center of the tumor and healthy tissue. In malignant tumors, oxidative stress values are significantly higher in all localizations compared to benign tumors.

The risks of ubiquinone and β-carotene deficiency and metabolic disorders in patients with oral cancer

Background

Cancer development is mediated by oxidative stress and inflammation, which may correlate with metabolic disorders. The aim of this study was to evaluate antioxidant vitamins status and metabolic parameters in patients with oral cancer according to tumor-node-metastasis (TNM) stages.

Methods

A total of 194 patients with oral cancer were enrolled in this study. The patients were stratified for four groups according to cancer stages and that the statistics are comparisons across these groups. The levels of antioxidant vitamins (ubiquinone, β-carotene, vitamin A and E), metabolic parameters, oxidative stress, antioxidant enzymes activity, and inflammatory markers were measured.

Results

More than half of the subjects had high blood pressure, central obesity, hyperglycemia, and hyperlipidemia regardless of TNM stage. With regard to antioxidant vitamins status, 46 and 94% of patients had β-carotene and ubiquinone deficiency, respectively. Patients in T3 and T4 stages had significantly lower antioxidant enzyme (catalase, p = 0.03) activity and higher inflammatory markers levels (high sensitivity C-reactive protein and interleukin-6, p < 0.01) than patients in the other stages. In addition, the level of β-carotene was negatively associated with waist circumference, and ubiquinone was positively associated with the level of high-density lipoprotein cholesterol (p < 0.05). Higher β-carotene and ubiquinone levels were negatively associated with hypertriglyceridemia and the risk of metabolic syndrome (p < 0.05).

Conclusions

A high proportion of patients with oral cancer had ubiquinone or β-carotene deficiency and metabolic disorders. The level of ubiquinone or β-carotene was negatively associated with the risk of central obesity, hypertriglyceridemia, and metabolic syndrome. Since patients with oral cancer suffer from high oxidative stress and inflammation (particularly in the T3 and T4 stages), supplementation with antioxidant vitamins such as ubiquinone or β-carotene could be preferentially applied.

Evaluation of enzymatic and non-enzymatic antioxidant status and biomarkers of oxidative stress in saliva of patients with oral squamous cell carcinoma and oral leukoplakia: a pilot study

Objective: The study aimed to evaluate total antioxidant capacity as well as levels of various enzymatic and non-enzymatic antioxidants, and oxidative stress markers in saliva of patients with oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL). Material and methods: Twenty patients with OSCC, 20 patients with OL and 20 healthy subjects were enrolled into this prospective study. Total Antioxidant Capacity (TAC), activity of superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GR) as well as levels of total glutathione (tGSH), reduced glutathione (GSH), oxidized glutathione (GSSG), GSH/GSSG ratio, uric acid (UA), 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) were estimated in saliva using appropriate biochemical methods. Results: The activity of SOD was significantly higher in OSCC group in comparison with OL and control groups. The levels of GSH were markedly lower in OSCC and OL patients as compared to the control group. Likewise, we found that GSH/GSSG ratio was markedly lower in the OSCC and OL groups. Levels of some biomarkers were influenced by clinical staging of OSCC and OL as well as by sociodemographic factors. Conclusions: The results of this pilot study suggest that salivary activity of SOD is higher in OSCC patients, whereas levels of GSH and GSH/GSSG ratio are lower in saliva of patients with OSCC and OL. Clinical staging of OSCC and OL, as well as some sociodemographic factors may also influence salivary antioxidant status.

Non-tumor adjacent tissue of advanced stage from CRC shows activated antioxidant response

Colorectal cancer (CRC) is a leading cause of malignant cancer-related morbidity and mortality, with a higher incidence in developed countries and a high mortality rate mainly attributable to metastases. The aim of the present study was to determine the metabolic adaptations related to oxidative stress in tumor tissue from advanced stages (III and IV) of CRC and whether they could be used as potential biomarkers for clinical applications. To tackle this aim, we have analyzed the protein expression levels related to oxidative stress and the enzymatic activities of MnSOD and catalase, comparing samples of non-tumor adjacent tissue and tumor tissue of CRC patients in stages III and IV. The results showed no differences between stage III and IV in tumor tissues for any of the proteins studied. However, some differences were found between samples of non-tumor adjacent tissue and tumor tissue for some of the antioxidant enzymes. Overwhelmingly, the greatest differences were detected when comparing samples of non-tumor adjacent tissue from stage III and stage IV. To the best of our knowledge, this is the first study where differences between the non-tumor adjacent tissues of CRC patients from different cancer stages were determined. This study suggests that the parameters analyzed should be evaluated as biomarkers for the evolution of CRC. Furthermore, tumor tissue status should not be of sole importance for the prognosis of CRC, as the non-tumor adjacent tissues could also merit consideration.

Significance of Serum Nitric Oxide and Superoxide Dismutase in Oral Submucous Fibrosis and Squamous Cell Carcinoma: A Comparative Study

Introduction:

This study aimed at comparative analysis of serum nitric oxide (NO) and superoxide dismutase (SOD) levels as therapeutic and prognostic biomarkers in patients with oral submucous fibrosis (OSMF) and squamous cell carcinoma (SCC).

Materials and Methods:

Eighty-seven patients were grouped into Group I (n = 29, OSMF), Group II (n = 29, oral SCC), and Group III (n = 29, controls). Two ml of venous blood was collected from patients after overnight fast to avoid any dietary influence on the serum beta-carotene. Standard protocols were followed in transfer, storage, and processing of blood. Modified copper-cadmium reduction method for rapid assay to estimate the serum NO and Enzychrom™ SOD assay kit to determine SOD levels were used.

Results:

The mean level of NO level in Group I, Group II, and Group III was 42.49, 50.08, and 32.81, respectively, and mean level of SOD in Group I, Group II, and Group III were 207.65, 196.93, and 226.57, respectively. The P values were calculated and were statistically significant (<0.001).

Conclusion:

An increase in level of oxidant NO in OSMF followed by SCC and decrease in level of antioxidant SOD in OSMF followed by SCC were noted. These levels of NO and antioxidant SOD can be used as prognostic and therapeutic biomarkers.

The interaction between antioxidant status and cervical cancer: A case control study

Aims and background

To compare the antioxidant status of cervical cancer patients with healthy controls and to assess the antioxidant levels before and after radiotherapy or radiochemotherapy

Methods and study design

Antioxidant levels (glutathione, glutathione peroxidase, superoxide dismutase, and malondialdehyde) were measured in 35 patients with cervical cancer and 35 age-matched healthy controls. Blood samples were collected twice (before and after treatment) from cervical cancer patients and once from healthy control subjects.

Results

In the patient group, pre-radiotherapy glutathione and glutathione peroxidase levels were significantly lower (P<0.01 and P<0.0001, respectively) than the control group. Pre-radiotherapy levels of superoxide dismutase were significantly higher in cancer patients (P<0.01). In general, no difference was observed between pre- and post-radiotherapy antioxidant levels in cancer patients. However, when post-radiotherapy glutathione levels were analyzed, patients who did not respond to treatment had significantly higher levels than those who did respond (P <0.01).

Conclusions

Levels of antioxidants significantly differed between the patients with cervical cancer and the controls, and no change in antioxidant levels was observed after treatment. Moreover, further studies evaluating the predictive value of glutathione levels on treatment response are warranted.

Evaluation of glutathione peroxidase in the blood and tumor tissue of oral squamous cell carcinoma patients

Aims and Objectives:

The lowered antioxidant capacity and the oxidant–antioxidant imbalance have been considered to play a role in multistage carcinogenesis. The deleterious effects produced by reactive oxygen species depend on the imbalance between oxidant and antioxidant status in the body, so this study is aimed to evaluate the levels of antioxidant enzyme, glutathione peroxidase (GPx), in the blood and tumor tissues of oral squamous cell carcinoma (OSCC) patients in comparison with healthy controls.

Materials and Methods:

The study comprised of 38 participants divided into two groups. Group 1 comprised of 20 patients with OSCC and Group 2 comprised of age- and sex-matched 18 healthy individuals free of any habits and systemic illness. The levels of GPx were estimated in the blood and tissue samples in both groups by Paglia and Valentine method using a Commercial Biochemical assay kit (RANDOX), by ultraviolet-visible spectrophotometer.

Results:

The GPx levels were elevated in the whole blood and the tissue samples of OSCC cases as compared to the control group. It was also found that the GPx levels were increased in the tumor tissue with respect to the histopathological grading of the OSCC cases.

Conclusion:

Detection of antioxidant status may be useful to choose correct radiotherapy or chemotherapy, to monitor the effectiveness of the therapeutic strategy and to determine tumor resistance to therapy. Hence, the evaluation of GPx enzyme level can be used as a prognostic marker in patients with OSCC.

Thioctic acid in oral submucous fibrosis (India's disease) - A better tomorrow

Oral submucous fibrosis (OSMF), because of its common occurrence in Indian population is known as India's disease. Regardless of diagnostic and therapeutic developments, oral potentially malignant disorders (PMD) and cancers are disseminating at a distressing rate. There is this prerequisite for unrelenting determination to find out apt treatment options so that malignant transformation may be prevented and more so the prevailing morbidity and mortality. Considering the frequency with which oral submucous fibrosis undergoes malignant transformation with free radicals playing a major part, the role of antioxidants in general and thioctic acid also known as alpha lipoic acid (ALA) in particular need to be studied in these individuals. Previous few studies indicated the use of alpha lipoic acid in oral submucous fibrosis patients leading to improvement in signs and symptoms. So, it led us to set forth and propose probable role of thioctic acid in improving symptoms in these patients. As oral submucous fibrosis poses as a threat with its various signs and symptoms and as a potentially malignant disorder as well as considering the role of free radicals in malignant transformation, we proposed the possible mechanisms behind the commonest signs and symptoms in oral submucous fibrosis and role of alpha lipoic acid in managing these signs and symptoms.

Comparative efficacy of epigallocatechin-3-gallate against H2O2-induced ROS in cervical cancer biopsies and HeLa cell lines

Aim of the study

Antioxidants play an important role in maintaining physiological homeostasis. Recent literature emphasises the potential therapeutic effects of natural antioxidants that play anti-inflammatory and antioxidant effects applicable in preventing oxidative stress-induced injury, which characterises their pathogenesis. The goal of this study was to evaluate the protective role of EGCG on the HeLa cell line and cancerous cells.

Material and methods

The HeLa cell line and cervical cancer biopsies (CCB) were treated with varying doses of antioxidants to determine their effects. Thereafter, hydrogen peroxide (0–10 nM) – an ROS-generating compound – was co-cultured with varying doses of epigallocatechin-3-gallate (EGCG). The effect of this compound on superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity was assessed.

Result

The activity of SOD and GPx was protected significantly in the treatment of EGCG in cervical cancer biopsies and HeLa cell line.

Hypothesis

It is hypothesised that EGCG has free radical scavenging properties.

Conclusions

EGCG protected the activity SOD and GPx equally in cervical cancer biopsies (CCB) and HeLa cell line.

Current relevance of hypoxia in head and neck cancer

Head and Neck cancer (HNC) is a complex mix of cancers and one of the more common cancers with a relatively poor prognosis. One of the factors that may assist us in predicting survival and allow us to adjust our treatment strategies is the presence of tumor hypoxia. In this overview we aim to evaluate the current evidence and potential clinical relevance of tumor hypoxia in head and neck cancer according to an extensive search of current literature.An abundance of evidence and often contradictory evidence is found in the literature. Even the contradictory evidence and comparisons are difficult to judge as criteria and methodologies differ greatly, furthermore few prospective observational studies exist for verification of the pre-clinical studies. Despite these discrepancies there is clear evidence of associations between prognosis and poor tumor oxygenation biomarkers such as HIF-1α, GLUT-1 and lactate, though these associations are not exclusive. The use of genetic markers is expanding and will probably lead to significantly more and complex evidence. The lack of oxygenation in head and neck tumors is of paramount importance for the prediction of treatment outcomes and prognosis. Despite the wide array of conflicting evidence, the drive towards non-invasive prediction of tumor hypoxia should continue.

Evaluation of salivary and serum lipid peroxidation, and glutathione in oral leukoplakia and oral squamous cell carcinoma

Lipid peroxidation induced by reactive oxygen species (ROS) is involved in the pathogenesis of malignancy. Overall, lipid peroxidation levels are indicated by malondialdehyde (MDA), which is the most frequently used biomarker to detect oxidative changes. Antioxidant defense systems such as glutathione (GSH) limit cell injury induced by ROS. Therefore, MDA and GSH can be used to monitor oxidative stress (OS). Hence, this study aimed to evaluate and compare both salivary and serum levels of MDA and GSH in oral leukoplakia and oral squamous cell carcinoma (OSCC) patients, and healthy controls. The study included 100 subjects comprising 30 apparently healthy controls, 30 patients with oral leukoplakia and 40 clinically and histologically diagnosed patients with OSCC. Saliva and blood samples were obtained and evaluated for MDA and GSH. The study revealed enhanced MDA levels in saliva and serum in oral leukoplakia and OSCC patients as compared to controls. On the other hand, significant decreases were seen in serum and salivary GSH levels in oral leukoplakia and OSCC patients as compared to controls. Augmentation of OS in blood and saliva is reflected by increase in MDA and decrease in GSH levels, indicating that tumor processes cause an imbalance of oxidant-antioxidant status in cell structures.

Evaluation of oxidant-antioxidant status in tissue samples in oral cancer: A case control study

Background:

Imbalances between the oxidant-antioxidant status have been implicated in the pathogenesis of several diseases, including cancer. The aim of this study was to evaluate the extent of lipid peroxidation and antioxidants in the tissue samples of oral squamous cell carcinoma (OSCC) patients of different clinical stages in comparison with the healthy controls.

Materials and Methods:

A case-control study was designed with 20 new histopathologically proven oral carcinoma patients and an equal number of age, sex, and tobacco chewing habit matched healthy subjects. Their tissue samples were subjected to evaluation of lipid peroxidation product and antioxidant enzymes, namely, superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), and glutathione peroxidase (GPx) using spectrophotometric methods. The data are expressed as mean ± standard deviation. The statistical comparisons between the study groups were performed by independent Student's unpaired t-test and one-way analysis of variance. Post-hoc analysis was performed for within study group comparisons. Karl Pearson correlation was performed for the biochemical parameters within the group and between the groups. For statistically significant correlations, simple linear regression was performed using SPSS (α=0.05).

Results:

Significant reduction in lipid peroxidation (P < 0.001) SOD and CAT (P < 0.001) was observed in the tissue of OSCC patients as compared with the healthy controls. On the other hand, reduced GSH and GPx were significantly increased in tumor samples.

Conclusion:

Reduced lipid peroxidation and increased activity of reduced GSH and GPx provides the suitable environment for the local growth and invasion of the tumor and metastasis in the later stages. Among the antioxidant enzymes, GSH reductase appears to have a profound role in carcinogenesis and thus it can be considered as potential prognostic marker.

Effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats

OBJECTIVE

To investigate the effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats.

METHODS

A total of 40 healthy male SD rats were randomly divided into the sham group (Group A, n=10, saline 5 mL/d), ischemia-reperfusion group (Group B, n=10, saline 5 mL/d), atorvastatin group (Group C, n=10, atorvastatin 20 mg/kg · d), atorvastatin + N-amino-arginine group (Group D, n=10, atorvastatin 20 mg/kg · d + N-amino arginine 15 mg/kg). Myocardial ischemia-reperfusion rat model was established after 3 days of gavage. N-amino arginine 15 mg/kg was given by tail vein injection 15 min before ischemia. After reperfusion, enzymology indicators such us creatine kinase (CK) and lactate dehydrogenase and the oxidative stress parameters such as nitric oxide (NO), malondialdehyde (MDA) and total superoxide dismutase (TSOD), and n-terminal pro-brain natriuretic peptide (NT-proBNP) expression was detected by immunohistochemistry.

RESULTS

LDH and CK levels of group A were significantly lower than the other three groups, and group B was the highest. There was significant difference between group B and group C (P<0.05), and no significant difference between group B and group D (P>0.05). MDA levels in group B were significantly higher than the other three groups. The lowest was group A, followed by group C, the difference among groups was significantly (P<0.05). TSOD and NO levels in group B was the lowest, the level in group A was the highest, followed by group C, the difference among groups was significant (P<0.05). NT-proBNP level in group B was significantly higher than the other three groups, the lowest was group A, followed by group C, the difference among groups was significant (P<0.05).

CONCLUSIONS

Atorvastatin has a protective effect on the myocardial injury in the myocardial ischemia and reperfusion rats. It can increase NO synthesis and decrease MDA content, increase serum TSOD activity and the oxidative stress effect, meanwhile protect myocardial cells and reduce myocardial injury.

DNA damage and oxidant-antioxidant status in blood of patients with head and neck cancer

Oxidative stress induces a cellular redox imbalance that has been found to be present in various cancer cells, and overproduction of free radicals may be related to oncogenic stimulation. We investigated the activity of the following antioxidant enzymes: superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) concentrations in blood of patients with head and neck squamous cell carcinoma (HNSCC) compared with the control group. A comet assay was used to assess DNA damage. A nonsignificant increase of MDA and a decrease of SOD, CAT, and GPx (p>0.05) were seen in HNSCC patients compared with controls. It was found that the level of oxidative DNA damage in HNSCC patients was significantly higher compared with the control group (p ≤ 0.001). Our observations suggest that HNSSC patients may represent an impaired antioxidant defense system, resulting in DNA damage and genome instability. It has to be also considered that an oxidant/antioxidant imbalance may be connected to the complex mechanism leading to the DNA damage indicated in the blood of patients with head and neck cancer.

Oxidative stress and mitochondrial dysfunction across broad-ranging pathologies: toward mitochondria-targeted clinical strategies

Beyond the disorders recognized as mitochondrial diseases, abnormalities in function and/or ultrastructure of mitochondria have been reported in several unrelated pathologies. These encompass ageing, malformations, and a number of genetic or acquired diseases, as diabetes and cardiologic, haematologic, organ-specific (e.g., eye or liver), neurologic and psychiatric, autoimmune, and dermatologic disorders. The mechanistic grounds for mitochondrial dysfunction (MDF) along with the occurrence of oxidative stress (OS) have been investigated within the pathogenesis of individual disorders or in groups of interrelated disorders. We attempt to review broad-ranging pathologies that involve mitochondrial-specific deficiencies or rely on cytosol-derived prooxidant states or on autoimmune-induced mitochondrial damage. The established knowledge in these subjects warrants studies aimed at elucidating several open questions that are highlighted in the present review. The relevance of OS and MDF in different pathologies may establish the grounds for chemoprevention trials aimed at compensating OS/MDF by means of antioxidants and mitochondrial nutrients.

Measurement of serum paraoxonase activity and MDA concentrations in patients suffering with oral squamous cell carcinoma

BACKGROUND

Oxidative stress is associated with many diseases including cancer. Oral squamous cell carcinoma (OSCC) is a prevalent cancer involving oral cavity. We evaluate the activity of paraoxonase 1 (PON1) in serum samples of subjects suffering from OSCC along with malondialdehyde (MDA) levels, a marker for oxidative stress. Antioxidant status in OSCC may reflect the role of oxidative imbalance in the disease.

METHODS

Forty-five patients suffering with OSCC and 30 healthy controls were selected for the study. Serum paraoxonase (PON) and arylesterase (ARE) activities were measured in subjects suffering from OSCC and their healthy counterparts. To examine the status of lipid peroxidation, MDA concentrations were estimated and a correlation was determined between PON activities and MDA concentrations. MDA expression in cancer and normal adjacent tissue was studied through immunohistochemical (IHC) analysis. Total reactive oxygen species (ROS) level was determined in serum from normal and diseased subjects. Our results revealed that both PON and ARE activities of PON1 were significantly decreased in OSCC patients. Serum MDA concentrations were inversely correlated to PON activity. Immunohistochemical analysis showed a higher expression of MDA in cancerous tissue. Total ROS levels were found to be significantly elevated in cancer subjects.

CONCLUSIONS

Along with other antioxidants, PON levels may act as an indicator of oxidative stress in cancer.

Levels of biological markers of nitric oxide in serum of patients with squamous cell carcinoma of the oral cavity

The aim of the study was a determination of the levels of nitric oxide (NO) and its biological markers such as malonyldialdehyde (MDA) and nitrotyrosine in the serum of patients with squamous cell carcinoma (SCC) of the oral cavity and identification of the relationships between NO and those markers. These studies were performed on patients with SCC of the oral cavity before and after treatment. Griess reaction was used for the estimation of the total concentration of NO in serum. The nitrotyrosine level in serum was assessed with an enzyme-linked immunosorbent assay (ELISA) kit, and MDA level using a spectrophotometric assay. Higher concentrations of NO in blood serum were determined in patients with stage IV of the disease before treatment in comparison to the control group and patients with stages II and III of the disease. Moreover, higher concentrations of MDA and nitrotyrosine were determined in the serum of patients in all stages of the disease in comparison to healthy people. After treatment, lower concentrations of NO in the serum of patients with stage IV of the disease were observed in comparison to the amounts obtained prior to treatment. In addition, lower levels of nitrotyrosine in the serum of patients with all stages of the disease were recorded, whereas higher concentrations of MDA were determined in these patients in comparison to results obtained before treatment. The compounds formed with the contribution of NO, such as MDA and nitrotyrosine, may lead to cancer progression in patients with SCC of the oral cavity, and contribute to formation of resistance to therapy in these patients as well. Moreover, the lack of a relationship between concentrations of NO and MDA, and between NO and nitrotyrosine in serum suggests that the process of lipid peroxidation and nitration in patients with SCC does not just depend on NO.

Circadian rhythm connections to oxidative stress: implications for human health

SIGNIFICANCE

Oxygen and circadian rhythmicity are essential in a myriad of physiological processes to maintain homeostasis, from blood pressure and sleep/wake cycles, down to cellular signaling pathways that play critical roles in health and disease. If the human body or cells experience significant stress, their ability to regulate internal systems, including redox levels and circadian rhythms, may become impaired. At cellular as well as organismal levels, impairment in redox regulation and circadian rhythms may lead to a number of adverse effects, including the manifestation of a variety of diseases such as heart diseases, neurodegenerative conditions, and cancer.

RECENT ADVANCES

Researchers have come to an understanding as to the basics of the circadian rhythm mechanism, as well as the importance of the numerous species of oxidative stress components. The effects of oxidative stress and dysregulated circadian rhythms have been a subject of intense investigations since they were first discovered, and recent investigations into the molecular mechanisms linking the two have started to elucidate the bases of their connection.

CRITICAL ISSUES

While much is known about the mechanics and importance of oxidative stress systems and circadian rhythms, the front where they interact has had very little research focused on it. This review discusses the idea that these two systems are together intricately involved in the healthy body, as well as in disease.

FUTURE DIRECTIONS

We believe that for a more efficacious management of diseases that have both circadian rhythm and oxidative stress components in their pathogenesis, targeting both systems in tandem would be far more successful.

Estimation of superoxide dismutase and glutathione peroxidase in oral submucous fibrosis, oral leukoplakia and oral cancer--a comparative study

Present study was undertaken to estimate and compare erythrocyte superoxide dismutase (E-SOD) and Glutathione peroxidase (GPx) levels in oral submucous fibrosis, oral leukoplakia and oral cancer patients and age/sex matched healthy subjects, 25 in each group. Statistically significant (P<0.001) decrease in E-SOD and GPx levels were observed in OSF, oral leukoplakia and oral cancer groups as compared to the control group. Oral leukoplakia group showed lower levels in comparison with OSF (P>0.05). Oral cancer group had the lowest levels amongst the study groups. Imbalance in antioxidant enzyme status may be considered as one of the factors responsible for the pathogenesis of cancer and may serve as a potential biomarker and therapeutic target to reduce the malignant transformation in oral premalignant lesions/conditions.

Serum and salivary levels of albumin as diagnostic tools for oral pre-malignancy and oral malignancy

The role of oxygen free radicals in the initiation, promotion and progression of carcinogenesis and the protective role of antioxidants has been a subject of much speculation. There are few studies that report evaluation of serum albumin and only one study in which salivary albumin was found and only one study that reports of salivary albumin in oral Leukoplakia and Oral Squamous Cell Carcinoma (OSCC). We evaluated serum and salivary albumin levels in normal individuals, patients with oral pre-malignancy and patients with oral malignancy, and we compared serum and salivary albumin levels in patients with oral pre-malignancy and oral malignancy. Our study comprised 45 subjects separated into three groups of 15: normal healthy, oral pre-malignancy and oral malignancy patients. Venous blood was drawn and unstimulated saliva was collected early in the morning. Albumin levels were estimated using the bromocresol green method. Serum albumin levels decreased in oral pre-malignancy and oral malignancy cases compared to healthy individuals. Salivary albumin levels increased in oral pre-malignancy and oral malignancy cases compared to healthy individuals. Our results suggest that albumin may play a role in early diagnosis and prognosis of oral pre-malignant and oral malignant tissues.

Synergic effect of curcumin or lycopene with irradiation upon oral squamous cell carcinoma cells

OBJECTIVE

An in vitro study was carried out to evaluate the effect of curcumin, lycopene, and irradiation upon oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

Curcumin and lycopene were administrated at doses of 3, 4.25, 5.50, and 6.75 μM in PE/CA-PJ15 OSCC cultures irradiated with different doses (1, 2.5, and 5 Gy), followed by evaluation of the effects upon cell viability, apoptosis, and migration after 24, 48, and 72 h of incubation.

RESULTS

The application of curcumin or lycopene to the tumor cells during 24, 48, and 72 h without irradiation exerted an inhibitor effect upon cell viability and increased cell apoptosis. The maximum reduction in cell viability and the peak apoptotic effect was recorded with the 5.50 and 6.75 μM doses, for both curcumin and lycopene. Likewise, curcumin and lycopene exerted a synergic effect upon both variables on applying irradiation. Lastly, the 5.50 and 6.75 μM drug doses, together with 5 Gy of irradiation, yielded the greatest decrease in cell migration capacity with both curcumin and lycopene.

CONCLUSIONS

Curcumin and lycopene increase cytotoxic activity in the PE/CA-PJ15 cell line and reduce cell migration capacity, while the combination of curcumin or lycopene with irradiation exerts a synergic effect.

Enterococcus faecalis enhances cell proliferation through hydrogen peroxide-mediated epidermal growth factor receptor activation

Enterococcus faecalis is a member of the intestinal and oral microbiota that may affect the etiology of colorectal and oral cancers. The mechanisms by which E. faecalis may contribute to the initiation and progression of these cancers remain uncertain. Epidermal growth factor receptor (EGFR) signaling is postulated to play a crucial role in oral carcinogenesis. A link between E. faecalis and EGFR signaling in oral cancer has not been elucidated. The present study aimed to evaluate the association between E. faecalis and oral cancer and to determine the underlying mechanisms that link E. faecalis to EGFR signaling. We report the high frequency of E. faecalis infection in oral tumors and the clinical association with EGFR activation. Using human oral cancer cells, we support the clinical findings and demonstrate that E. faecalis can induce EGFR activation and cell proliferation. E. faecalis activates EGFR through production of H(2)O(2), a signaling molecule that activates several signaling pathways. Inhibitors of H(2)O(2) (catalase) and EGFR (gefitinib) significantly blocked E. faecalis-induced EGFR activation and cell proliferation. Therefore, E. faecalis infection of oral tumor tissues suggests a possible association between E. faecalis infection and oral carcinogenesis. Interaction of E. faecalis with host cells and production of H(2)O(2) increase EGFR activation, thereby contributing to cell proliferation.

The oxidant/antioxidant status and cell death mode in oral squamous cell carcinoma

OBJECTIVE

Oxidative stress and imbalance in the oxidant/antioxidant system have a critical role in carcinogenesis by affecting necrosis and apoptosis. The aim of this study is to evaluate the oxidant/antioxidant status and cell death modes in patients with oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

Twenty-nine patients with OSCC and 29 control subjects were included in the study. The levels of malondialdehyde (MDA), advanced oxidation protein products (AOPP) and ferric reducing antioxidant power (FRAP) were determined in plasma samples of all subjects. The necrotic and apoptotic cell death modes were evaluated with M65 ELISA and M30 ELISA, respectively.

RESULTS

MDA and AOPP values as oxidative stress markers were higher in patients with OSCC than in the control group. FRAP values evaluating plasma antioxidant status increased in OSCC patients. M65 and M30 levels indicating necrosis and apoptosis were significantly higher in OSCC patients compared to controls. There were significant correlations between MDA, AOPP and FRAP; M65 and M30 values.

CONCLUSIONS

The elevated levels of oxidative stress markers together with the increase of antioxidant capacity and the presence of a strong correlation between MDA, AOPP and FRAP suggest an activation of antioxidant defense against accentuated oxidative stress determined in OSCC. Enhanced oxidation of lipids and proteins may cause decomposition of cell membranes with subsequent leakage of cytoskeletal cytokeratins as CK18 and caspase-cleaved CK18 (evaluated as M65 and M30, respectively) in the circulation, suggesting that both cell death modes are affected in OSCC.

Nitric oxide and oral cancer: a review

Nitric oxide (NO), a short-lived, endogenously produced gas, plays key role in various physiological as well as pathological processes. NO-inducing cell signaling events within the cell producing it and the diffusibility of it in other cells have led to the discovery of various physiological functions of NO including vasodilation, respiration, cell migration, immune response and apoptosis. On the other hand, excessive and unregulated NO synthesis has been implicated in many pathophysiological conditions including cancer. Research on NO, during the past few years is one of the growing areas in cancer biology. The high incidence of oral cancer and precancer has been linked with habits of tobacco chewing and smoking and NO has been said as the "messenger of death" in tobacco related diseases. NO seems to play a part in various stages of carcinogenesis from initiation to progression. However, there is considerable controversy and confusion in understanding its role in cancer biology. It is said to have both, tumoricidal as well as tumor promoting effects and these depend on its timing, location and concentration. Further, NO has also been shown to have antitumor, chemopreventive and therapeutic abilities. Here is an overview in which efforts are made to understand the role of this molecule in oral carcinogenesis.

Enhanced nitrosative and oxidative stress with decreased total antioxidant capacity in patients with oral precancer and oral squamous cell carcinoma

OBJECTIVE

Interaction between reactive oxygen species (ROS) and reactive nitrogen species (RNS) is a crucial determinant in the etiology of oral squamous cell carcinoma (OSCC), and antioxidants protect against cellular and molecular damage caused by these. This study aims to evaluate ROS and RNS, together with the total antioxidant capacity (TAC), in serum and tissues of OSCC patients.

METHOD

Total nitric oxide (TNO), malondialdehyde (MDA), and TAC were evaluated using a UV visible spectrophotometer in the serum of 30 controls, 30 precancer and 30 OSCC patients and in tissues of 10 controls and 30 OSCC patients.

RESULTS

MDA and TNO were significantly elevated with concomitant depletion of TAC in serum and tissues of OSCC patients when compared to controls. A significant positive correlation (p = 0.01), at different levels between TNO and MDA in OSCC patients, was found, which increased with the grade of OSCC.

CONCLUSION

An increase in the levels of TNO, NO-mediated lipid peroxidation, resulting in an increase in MDA levels, the positive TNO-MDA correlation with a deranged antioxidant defense system as demonstrated by significantly low levels of TAC; when all these facts are taken together, we can conjecture that oxidative DNA damage, a vital phenomenon for carcinogenesis, occurs due to the interplay of ROS, RNS and TAC.

Mechanisms associated with mitochondrial-generated reactive oxygen species in cancer

The mitochondria are unique cellular organelles that contain their own genome and, in conjunction with the nucleus, are able to transcribe and translate genes encoding components of the electron transport chain (ETC). To do so, the mitochondria must communicate with the nucleus via the production of reactive oxygen species (ROS) such as hydrogen peroxide (H2O2), which are produced as a byproduct of aerobic respiration within the mitochondria. Mitochondrial signaling is proposed to be altered in cancer cells, where the mitochondria are frequently found to harbor mutations within their genome and display altered functional characteristics leading to increased glycolysis. As signaling molecules, ROS oxidize and inhibit MAPK phosphatases resulting in enhanced proliferation and survival, an effect particularly advantageous to cancer cells. In terms of transcriptional regulation, ROS affect the phosphorylation, activation, oxidation, and DNA binding of transcription factors such as AP-1, NF-kappaB, p53, and HIF-1alpha, leading to changes in target gene expression. Increased ROS production by defective cancer cell mitochondria also results in the upregulation of the transcription factor Ets-1, a factor that has been increasingly associated with aggressive cancers.

Lycopene: features and potential significance in the oral cancer and precancerous lesions

Data from epidemiological studies have indicated that diets rich in fruits and vegetables are likely to benefit many aspects of the prevention of oral malignancy. Lycopene is a red-coloured carotenoid predominantly accumulated in tomatoes as well as other fruits and vegetables. It has been claimed to alleviate chronic diseases such as cancers and cardiovascular disease. Hence, the aim of this review is to summarize the features and its potential significance of lycopene in the development, prevention and treatment of oral premalignant lesions and oral cancer. Studies showed that lycopene might have beneficial effects in the management of some premalignant lesions in the oral cavity including oral submucous fibrosis and oral leukoplakia and may be an adjunct in the prevention and therapy of oral cancer. However, more mechanistic studies and randomized controlled trials of large sample size are necessary to further confirm these effects and to eventually make lycopene to be used in the community prevention and clinically routine management of these diseases.

Ets-1 regulates energy metabolism in cancer cells

Cancer cells predominantly utilize glycolysis for ATP production even in the presence of abundant oxygen, an environment that would normally result in energy production through oxidative phosphorylation. Although the molecular mechanism for this metabolic switch to aerobic glycolysis has not been fully elucidated, it is likely that mitochondrial damage to the electron transport chain and the resulting increased production of reactive oxygen species are significant driving forces. In this study, we have investigated the role of the transcription factor Ets-1 in the regulation of mitochondrial function and metabolism. Ets-1 was over-expressed using a stably-incorporated tetracycline-inducible expression vector in the ovarian cancer cell line 2008, which does not express detectable basal levels of Ets-1 protein. Microarray analysis of the effects of Ets-1 over-expression in these ovarian cancer cells shows that Ets-1 up-regulates key enzymes involved in glycolysis and associated feeder pathways, fatty acid metabolism, and antioxidant defense. In contrast, Ets-1 down-regulates genes involved in the citric acid cycle, electron transport chain, and mitochondrial proteins. At the functional level, we have found that Ets-1 expression is directly correlated with cellular oxygen consumption whereby increased expression causes decreased oxygen consumption. Ets-1 over-expression also caused increased sensitivity to glycolytic inhibitors, as well as growth inhibition in a glucose-depleted culture environment. Collectively our findings demonstrate that Ets-1 is involved in the regulation of cellular metabolism and response to oxidative stress in ovarian cancer cells.

The heme oxygenase system and oral diseases

Oral Diseases (2011) 17, 252-257 Heme oxygenase (HO) system catabolizes heme into three products: carbon monoxide (CO), biliverdin/bilirubin and free iron, which consists of three forms identified to date: the oxidative stress-inducible protein HO-1 and the constitutive isozymes HO-2 and HO-3. HO has been involved in many physiological and pathophysiological processes, ranging from Alzheimer's disease to cancer. The interest in HO system by scientists and clinicians involved with the oral and maxillofacial region is fairly recent, and few papers currently cited on HO relate to diseases in this anatomical area. This review will focus on the current understanding of the physiological significance of HO-1 induction and its possible roles in the oral diseases studied to date. The implications for possible therapeutic manipulation of HO are also discussed.