Salivary Tumour Necrosis Factor-α as a Biomarker in Oral Leukoplakia and Oral Squamous Cell Carcinoma

Salivary biomarkers: a promising approach for predicting immunotherapy response in head and neck cancers

Head and neck cancers, including cancers of the mouth, throat, voice box, salivary glands, and nose, are a significant global health issue. Radiotherapy and surgery are commonly used treatments. However, due to treatment resistance and disease recurrence, new approaches such as immunotherapy are being explored. Immune checkpoint inhibitors (ICIs) have shown promise, but patient responses vary, necessitating predictive markers to guide appropriate treatment selection. This study investigates the potential of non-invasive biomarkers found in saliva, oral rinses, and tumor-derived exosomes to predict ICI response in head and neck cancer patients. The tumor microenvironment significantly impacts immunotherapy efficacy. Oral biomarkers can provide valuable information on composition, such as immune cell presence and checkpoint expression. Elevated tumor mutation load is also associated with heightened immunogenicity and ICI responsiveness. Furthermore, the oral microbiota may influence treatment outcomes. Current research aims to identify predictive salivary biomarkers. Initial studies indicate that tumor-derived exosomes and miRNAs present in saliva could identify immunosuppressive pathways and predict ICI response. While tissue-based markers like PD-L1 have limitations, combining multiple oral fluid biomarkers could create a robust panel to guide treatment decisions and advance personalized immunotherapy for head and neck cancer patients.

Gold nanoparticle enhanced TNFα antibody interface using saliva for predicting prognosis in OSCC

OBJECTIVES

To assess the efficacy of the AuNP-enhanced ELISA in the detection of salivary TNF-α in OSCC and evaluate its predictive value for survival.

DESIGN

A longitudinal study was conducted on 40 OSCC patients and 10 healthy controls. Saliva was collected at a regular interval and TNF alpha levels were measured using ELISA and AuNP-enhanced ELISA. Descriptive statistics were carried out for demographic, clinical, and biomarker data. The efficacy of ELISA and AuNP-enhanced ELISA was estimated and compared using the ROC curve. Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess the survival outcome. A neural network model was performed to estimate TNF-α levels over time in OSCC patients.

RESULTS

OSCC patients (ELISA is 47.52 ± 20.23 and Gold nano-enhanced ELISA is 57.63 ± 24.99) exhibited significantly elevated TNFα levels compared to controls (ELISA is 10.13 ± 3.07and Gold nano-enhanced ELISA is 12.07 ± 3.66). Gold nano-enhanced ELISA (AUC of 0.995) demonstrated superior sensitivity than ELISA (AUC of 0.986), while Gold nano-enhanced ELISA achieves an even higher in detecting elevated TNFα levels. Kaplan-Meier analysis shows that Gold nano-enhanced ELISA outperforms ELISA in capturing survival trends, with better survival for TNF-α levels above the cutoff at 9 months (70 % vs. 60 %) and 24 months (40 % vs. 0 %). The neural network model poorly predicted TNF- levels over the period (AUC = 0.447).

CONCLUSIONS

The gold nano-enhanced TNFα detection method is effective in detecting TNFα levels between OSCC patients and controls, demonstrating superior sensitivity in identifying survival trends over time compared to traditional ELISA.

The Use of Diagnostic Tumor Markers in Detecting Tobacco- and Betel Quid-Induced Oral Squamous Cell Carcinoma: A Scoping Review of Empirical Evidence

Background and Aims

Tobacco and betel quid are two major causes of oral squamous cell carcinoma (OSCC). Tumor biomarkers offer potential headway for improved diagnosis of OSCC caused by tobacco and betel quid. Currently, several empirical investigations have explored the use of diverse types of tumor biomarkers in the diagnosis of tobacco- and betel quid-induced OSCC; however, no known study has mapped the evidence reported in those studies. This scoping review aims to map existing empirical evidence on the biomarkers of OSCC caused by these carcinogenic substances.

Methods

This scoping review adhered to the PRISMA-ScR checklist. Seven databases (PubMed, SCOPUS, AMED, APA PsycArticles, APA PsycINFO, CINAHL Ultimate, Dentistry, and Oral Sciences Source) were searched to retrieve literature on diagnostic tumor markers used in detecting tobacco- and betel quid-induced OSCC. After deduplication and screening of research articles based on the eligibility criteria. Only 36 peer-reviewed articles met the inclusion criteria of the scoping review. Data from the selected articles were charted, collated, summarized, and presented.

Results

All the included articles were on studies published within the past decade. Most of them (26 articles) reported case-control studies. More than half (20 articles) were on studies conducted in India. A total of 6707 participants were investigated in the included articles, and different oral anatomical sites were involved. The biomarkers investigated were of diverse types, ranging from genomic biomarkers to transcriptomic markers. Specifically, these markers include micronuclei, miRNAs, protein markers, gene alterations, and salivary markers. These biomarkers were used in the early detection, risk assessment, and prognosis evaluation of tobacco-/betel quid-induced OSCC.

Conclusion

This scoping review provides insights into the current global research landscape on the use of biomarkers in the diagnosis of tobacco- and betel quid-induced OSCC; it also provides potential avenues for improving early detection and management of this prevalent oral malignancy.

In Situ Ag-Seeded Lamellar Ti3C2 Nanosheets: An Electroactive Interface for Noninvasive Diagnosis of Oral Carcinoma via Salivary TNF-α Sensing

In the fast-paced quest for early cancer detection, noninvasive screening techniques have emerged as game-changers, offering simple and accessible avenues for precession diagnostics. In line with this, our study highlights the potential of silver nanoparticle-decorated titanium carbide MXene nanosheets (Ti3C2_AgNPs) as an electroactive interface for the noninvasive diagnosis of oral carcinoma based on the prevalence of the salivary biomarker, tumor necrosis factor-α (TNF-α). An in situ reduction was utilized to synthesize the Ti3C2_AgNPs nanohybrid, wherein Ti3C2 acts as the reducing agent, and the resulting nanohybrid was subjected to various characterization techniques to examine the optical, structural, and morphological attributes. The results revealed that spherical AgNPs formed on the surface of Ti3C2 MXene nanosheets by virtue of the low-valent Ti species present in Ti3C2, which facilitated the reduction of AgNO3 to AgNPs. Furthermore, the electrochemical characterization of the nanohybrid-modified screen-printed electrode (Ti3C2_AgNPs/SPE) indicated enhanced heterogeneous electron transfer kinetics. With these encouraging results, the Ti3C2_AgNPs nanohybrid was employed as an immobilization matrix for TNF-α antibodies and applied for electrochemical sensing. Analytical studies of the fabricated immunosensor, conducted by differential pulse voltammetry (DPV), exhibited a broader linear range (1 to 180 pg mL-1), a low limit of detection (0.97 pg mL-1), and high sensitivity (1.214 μA mL pg-1 cm-2) and specificity, even in artificial saliva, indicating its reliability for oral carcinoma diagnosis. Therefore, the Ti3C2_AgNP nanohybrid seems a promising candidate for the effective sensing of TNF-α and could also be explored for other biomarkers.

Salivaomics: A Revolutionary Non-invasive Approach for Oral Cancer Detection

Salivaomics has emerged as a ground-breaking field in the detection and management of oral cancer (OC), offering a non-invasive, efficient, and patient-friendly alternative to traditional diagnostic methods. This innovative approach leverages the comprehensive molecular insights provided by genomics, transcriptomics, proteomics, metabolomics, and microbiomics. The potential of salivaomics lies in its ability to enable early detection, predict malignant transformation, and monitor treatment outcomes and disease recurrence. Advancing salivary diagnostics necessitates the standardization of saliva collection and processing protocols, identification and validation of robust biomarkers, and development of cutting-edge detection technologies. A single biomarker is unlikely to fulfill all diagnostic requirements; thus, research should focus on developing a panel of biomolecules to enhance diagnostic accuracy and management of OC. Salivaomics stands at the forefront of non-invasive diagnostic methods, with the promise to revolutionize early detection and management of OC. Future research directions should emphasize the integration of multi-omics data for superior biomarker discovery, the development of portable and cost-effective point-of-care devices, and the fostering of interdisciplinary collaborations to drive innovation. Overcoming these challenges will facilitate the translation of salivaomics into routine clinical practice, significantly improving early diagnosis, treatment, and prognosis of OC. This review provides a comprehensive overview of salivaomics, detailing the use of saliva as a diagnostic fluid. It covers saliva collection, preparation, transportation, storage methods, and various analytical techniques. Additionally, the review discusses the current challenges and future directions of this transformative technology, emphasizing its potential to enhance clinical outcomes in OC.

A bioinspired porous and electroactive reduced graphene oxide hydrogel based biosensing platform for efficient detection of tumor necrosis factor-α

Oral cancer is one of the leading cancer types, which is frequently diagnosed at an advanced stage, giving patients a poor prognosis and fewer therapeutic choices. To address this gap, exploiting biosensors utilizing anti-biofouling hydrogels for early-stage oral cancer detection in non-invasive body fluids is gaining utter importance. Herein, we have demonstrated the fabrication of an innovative electrochemical immunosensor for the rapid, label-free, non-invasive, and affordable detection of tumor necrosis factor-α (TNF-α), a biomarker associated with oral cancer progression in artificial saliva samples. The gold screen-printed electrodes (gSPEs) are modified with a green synthesized porous and electroactive reduced graphene oxide (rGO) hydrogel utilizing L-cystine (L-cys) as both in situ reducing and surface functionalization agent, followed by covalent immobilization of anti-TNF-α and blocking of residual sites with bovine serum albumin (BSA) to fabricate the BSA/anti-TNF-α/L-cys_rGO hydrogel/gSPE immunosensing platform. The fabricated platform demonstrates excellent performance, with a low limit of detection of 1.20 pg mL-1, a broad linear range from 1 to 200 pg mL-1, and a high sensitivity of 2.10 μA pg-1 mL cm-2 carried out with differential pulse voltammetry (DPV) technique. Moreover, it exhibits specificity towards TNF-α, even in the presence of potential interferents and other cancer biomarkers. Besides, the biosensor showed good reproducibility and repeatability with a relative standard deviation (%RSD) of 5.11% and 1.85%, respectively. Thus, integrating the L-cys_rGO hydrogel in the immunosensor design offers enhanced performance, paving the way for its application in early-stage oral cancer diagnosis.

Biological biomarkers of oral cancer

The oral squamous cell carcinoma (OSCC) 5 year survival rate of 41% has marginally improved in the last few years, with less than a 1% improvement per year from 2005 to 2017, with higher survival rates when detected at early stages. Based on histopathological grading of oral dysplasia, it is estimated that severe dysplasia has a malignant transformation rate of 7%-50%. Despite these numbers, oral dysplasia grading does not reliably predict its clinical behavior. Thus, more accurate markers predicting oral dysplasia progression to cancer would enable better targeting of these lesions for closer follow-up, especially in the early stages of the disease. In this context, molecular biomarkers derived from genetics, proteins, and metabolites play key roles in clinical oncology. These molecular signatures can help predict the likelihood of OSCC development and/or progression and have the potential to detect the disease at an early stage and, support treatment decision-making and predict treatment responsiveness. Also, identifying reliable biomarkers for OSCC detection that can be obtained non-invasively would enhance management of OSCC. This review will discuss biomarkers for OSCC that have emerged from different biological areas, including genomics, transcriptomics, proteomics, metabolomics, immunomics, and microbiomics.

Salivary cysteine levels as a potential biochemical indicator of oral cancer risk in tobacco consumers

Aim: Oral cancer is the leading cause of mortality, with a survival rate of less than 5 years, and is predominantly influenced by tobacco mutagens. Invasive diagnostic methods hinder early detection of oral cancer biomarkers. The present study performed salivary biochemical analysis for early oral cancer screening in tobacco consumers.Materials & methods: Three study groups included healthy controls (n = 25), tobacco users (n = 25) and oral cancer patients (n = 25). Salivary total protein, amylase, TNF-α and amino acid levels were evaluated using enzymatic tests, Enzyme linked Immunosorbent Assay (ELISA) and High-Performance Liquid Chromatography (HPLC).Results: Compared with healthy controls, salivary total protein and TNF-α levels were significantly (p = 0.04) higher in oral cancer patients. Salivary amylase levels were significantly lower in tobacco smokers (p = 0.02) and higher in oral cancer patients (p = 0.01). Interestingly, the amino acid cysteine concentration was significantly higher (p = 0.02) in tobacco consumers (62.5 ± 10) than in healthy controls (116.1 ± 28).Conclusion: In high-risk populations, such as tobacco users, salivary biochemical analysis can serve as a promising noninvasive diagnostic method for early oral cancer screening. As a salivary biomarker, the amino acid cysteine exhibits potential as a means of detecting the progression of oral cancer in individuals who consume tobacco.

Salivary biomarkers in non-invasive oral cancer diagnostics: a comprehensive review

OBJECTIVE

This review aims to provide a comprehensive analysis of the effectiveness of saliva as a non-invasive diagnostic marker for oral cancer. Despite progress in oral cancer diagnosis and prognosis, the 5-year survival rate remains low due to the resistance to treatment and delayed diagnosis, which can be attributed to various factors including tobacco and alcohol consumption, genetic damage, and human papillomavirus (HPV). The potential use of saliva as an easily accessible non-invasive screening and diagnostic method arises from its direct contact with the lesion site.

METHODOLOGY

Data for this study were gathered via a comprehensive literature evaluation using search engines such as the PubMed, Web of Science, Google Scholar, and SciFinder.

RESULTS

Identifying salivary biomarkers shows potential to transform oral cancer diagnostics by offering a reliable alternative to the traditional invasive methods. Saliva is an abundant reservoir for both cell-bound and cell-free organic and inorganic constituents. Thus, saliva is an appropriate field for research in proteomics, genomics, metagenomics, and metabolomics.

CONCLUSION

This review provides a comprehensive elucidation of salivary biomarkers and their function in non-invasive oral cancer diagnosis, demonstrating their potential to enhance patient outcomes and reduce the impact of this devastating disease.

Salivary biomarkers: Effective diagnostic tool for oral leukoplakia and oral squamous cell carcinoma

OBJECTIVE

To identify potential salivary biomarkers for the diagnosis and monitoring of disease progression in oral squamous cell carcinoma and oral leukoplakia.

MATERIALS AND METHODS

An advance search from PubMed and Hindawi was performed with keywords; oral leukoplakia/oral squamous cell carcinoma, salivary biomarker and diagnosis/prognosis. An additional search of articles was done through a manual search from the Google Scholar database.

RESULTS

Twenty studies involving salivary biomarkers as diagnostic tools for oral squamous cell carcinoma and/or oral leukoplakia were identified. A narrative review was carried out.

CONCLUSION

Single or multiple salivary biomarkers reported by most studies have shown great potential as diagnostic tools for oral squamous cell carcinoma and oral leukoplakia. However, the validation of sensitivity and specificity should be carried out to ensure the accuracy of the biomarkers. Furthermore, a standardised method for saliva collection should be established to prevent variability in the expression of biomarkers.

Assessment of TNF-α (-857 C/T) gene polymorphism in oral lichen planus disease: A case-control study

Background and aims

Oral lichen planus (OLP) is an inflammatory mucocutaneous disorder with an immune-mediated pathogenesis. The tumor necrosis factor-α (TNF-α) level in the serum of OLP patients is significantly higher than in the control group. TNF-α-857 C/T polymorphism can be related to the increased TNF-α level in blood circulation. This study investigated the relationship between TNF-α (-857 C/T) polymorphism and OLP patients in an Iranian population.

Methods

Saliva samples were taken from 200 people, including 100 patients with OLP and 100 healthy people who did not have significant differences in age and sex. Then, DNA was extracted from them and the TNF-α (-857 C/T) genotype was identified using the polymerase chain reaction with confronting two-pair primers method. Statistical Package for the Social Sciences version 16 software analyzed the results.

Results

The frequency of C/C, C/T, and T/T genotypes of the TNF-α-857 C/T polymorphism in the patient group were 78%, 18%, and 4%, respectively, and in the control group were 72%, 23%, and 5%, respectively. The differences between the two groups regarding allele (χ 2  =  0.97, p  = 0.32) and genotype (χ 2  =  0.96, p  = 0.62) frequency among the studied population were insignificant.

Conclusion

This study showed that the difference in the frequency of single nucleotide polymorphism TNF-α-857 C/T polymorphism in the patient and control group had no significant relationship with the increased OLP incidence. Also, no significant association was observed between allele and genotype frequency of TNF-α (-857 C/T) with OLP subtypes.

Shaping the future of oral cancer diagnosis: advances in salivary proteomics

INTRODUCTION

Saliva has gained increasing attention in the quest for disease biomarkers. Because it is a biological fluid that can be collected is an easy, painless, and safe way, it has been increasingly studied for the identification of oral cancer biomarkers. This is particularly important because oral cancer is often diagnosed at late stages with a poor prognosis.

AREAS COVERED

The review addresses the evolution of the experimental approaches used in salivary proteomics studies of oral cancer over the years and outlines advantages and pitfalls related to each one. In addition, examines the current landscape of oral cancer biomarker discovery and translation focusing on salivary proteomic studies. This discussion is based on an extensive literature search (PubMed, Scopus and Google Scholar).

EXPERT OPINION

The introduction of mass spectrometry has revolutionized the study of salivary proteomics. In the future, the focus will be on refining existing methods and introducing powerful experimental techniques such as mass spectrometry with selected reaction monitoring, which, despite their effectiveness, are still underutilized due to their high cost. In addition, conducting studies with larger cohorts and establishing standardized protocols for salivary proteomics are key challenges that need to be addressed in the coming years.

P N. Evaluation of salivary tumor necrosis factor α as a diagnostic biomarker in oral submucosal fibrosis and squamous cell carcinoma of the oral cavity and oropharynx: a cross sectional observational study

Introduction

Tumor necrosis factor α (TNF-α) is known to be associated with chronic inflammation, and its expression has been shown to increase in advanced cancers. Chronic inflammation is a characteristic feature of oral submucous fibrosis (OSMF), which is a potentially malignant disorder (PMD). Squamous cell carcinoma (SCC) is associated with considerable mortality and morbidity and an early detection or monitoring would greatly help in achieving an effective cure. TNF-α was thus evaluated for use as a biomarker in the present study according to the stage of OSMF and histological grade of SCC in the oral cavity and oropharynx.

Methods

This study included 45 patients divided into 3 groups-OSMF group, SCC group and control group-each comprising 15 participants. Saliva samples were collected from each patient, and salivary TNF-α levels were estimated using an ELISA kit.

Results

Statistical analysis revealed no significant differences in TNF-α levels among the OSMF, SCC and control groups; however, there was an increase in the salivary TNF-α level in patients with stage 3 disease according to the clinical stage of OSMF, for which the p value was 0.027.

Discussion

An increase in the TNF-α concentration with increasing clinical stage suggested a role for TNF-α in the spread of OSMF involvement in anatomical structures of the oral cavity and oropharynx. No significant difference in salivary TNF-α levels was noted among the OSMF, SCC and control groups.

Conclusion

The study showed a positive correlation of TNF-α with increasing stages of OSMF but was not a reliable biomarker in the categorization of the same.

Salivary Biomarkers for Oral Cancer Detection: An Exploratory Systematic Review

Different efforts have been made to find better and less invasive methods for the diagnosis and prediction of oral cancer, such as the study of saliva as a source of biomarkers. The aim of this study was to perform a scoping review about salivary molecules that have been assessed as possible biomarkers for the diagnosis of oral squamous cell carcinoma (OSCC). A search was conducted using EBSCO, PubMed (MEDLINE), Scopus, and Web of Science. The research question was as follows: which molecules present in saliva have utility to be used as biomarkers for the early detection of oral cancer? Sixty-two studies were included. Over 100 molecules were assessed. Most of the markers were oriented towards the early diagnosis of OSCC and were classified based on their ability for detecting OSCC and oral potentially malignant disorders (OPMDs), OSCC outcome prediction, and the prediction of the malignant transformation of OPMDs. TNF-α, IL-1β, IL-6 IL-8, LDH, and MMP-9 were the most studied, with almost all studies reporting high sensitivity and specificity values. TNF-α, IL-1β, IL-6 IL-8, LDH, and MMP-9 are the most promising salivary biomarkers. However, more studies with larger cohorts are needed before translating the use of these biomarkers to clinical settings.

Saliva as a potential non-invasive liquid biopsy for early and easy diagnosis/prognosis of head and neck cancer

Head and neck squamous cell carcinomas (HNSCCs) are the most devastating diseases in India and southeast Asia. It is a preventable and curable disease if detected early. Tobacco and alcohol consumption are the two major risk-factors but infection of high-risk HPVs are also associated with development of predominantly oral and oropharyngeal carcinomas. Interestingly, unlike cervical cancer, HPV-induced HNSCCs show good prognosis and better survival in contrast, majority of tobacco-associated HPV-ve HNSCCs are highly aggressive with poor clinical outcome. Biomarker analysis in circulatory body-fluids for early cancer diagnosis, prognosis and treatment monitoring are becoming important in clinical practice. Early diagnosis using non-invasive saliva for oral or other diseases plays an important role in successful treatment and better prognosis. Saliva mirrors the body's state of health as it comes into direct contact with oral lesions and needs no trained manpower to collect, making it a suitable bio-fluid of choice for screening. Saliva can be used to detect not only virus, bacteria and other biomarkers but variety of molecular and genetic markers for an early detection, treatment and monitoring cancer and other diseases. The performance of saliva-based diagnostics are reported to be highly (≥95 %) sensitive and specific indicating the test's ability to correctly identify true positive or negative cases. This review focuses on the potentials of saliva in the early detection of not only HPV or other pathogens but also identification of highly reliable gene mutations, oral-microbiomes, metabolites, salivary cytokines, non-coding RNAs and exosomal miRNAs. It also discusses the importance of saliva as a reliable, cost-effective and an easy alternative to invasive procedures.

An Intelligent System to Improve Diagnostic Support for Oral Squamous Cell Carcinoma

Oral squamous cell carcinoma (OSCC) is one of the most-prevalent cancer types worldwide, and it poses a serious threat to public health due to its high mortality and morbidity rates. OSCC typically has a poor prognosis, significantly reducing the chances of patient survival. Therefore, early detection is crucial to achieving a favorable prognosis by providing prompt treatment and increasing the chances of remission. Salivary biomarkers have been established in numerous studies to be a trustworthy and non-invasive alternative for early cancer detection. In this sense, we propose an intelligent system that utilizes feed-forward artificial neural networks to classify carcinoma with salivary biomarkers extracted from control and OSCC patient samples. We conducted experiments using various salivary biomarkers, ranging from 1 to 51, to train the model, and we achieved excellent results with precision, sensitivity, and specificity values of 98.53%, 96.30%, and 97.56%, respectively. Our system effectively classified the initial cases of OSCC with different amounts of biomarkers, aiding medical professionals in decision-making and providing a more-accurate diagnosis. This could contribute to a higher chance of treatment success and patient survival. Furthermore, the minimalist configuration of our model presents the potential for incorporation into resource-limited devices or environments.

Salivary Chemical Barrier Proteins in Oral Squamous Cell Carcinoma-Alterations in the Defense Mechanism of the Oral Cavity

Oral squamous cell carcinoma (OSCC) is one of the most frequent types of head and neck cancer. Despite the genetic and environmental risk factors, OSCC is also associated with microbial infections and/or dysbiosis. The secreted saliva serves as the chemical barrier of the oral cavity and, since OSCC can alter the protein composition of saliva, our aim was to analyze the effect of OSCC on the salivary chemical barrier proteins. Publicly available datasets regarding the analysis of salivary proteins from patients with OSCC and controls were collected and examined in order to identify differentially expressed chemical barrier proteins. Network analysis and gene ontology (GO) classification of the differentially expressed chemical barrier proteins were performed as well. One hundred and twenty-seven proteins showing different expression pattern between the OSCC and control groups were found. Protein-protein interaction networks of up- and down-regulated proteins were constructed and analyzed. The main hub proteins (IL-6, IL-1B, IL-8, TNF, APOA1, APOA2, APOB, APOC3, APOE, and HP) were identified and the enriched GO terms were examined. Our study highlighted the importance of the chemical barrier of saliva in the development of OSCC.

Role of selected salivary inflammatory cytokines in the diagnosis and prognosis of oral squamous cell carcinoma. A Systematic Review and Meta-analysis

BACKGROUND

Oral squamous cell carcinoma (OSCC) is gradually increasing its incidence in our society. Unfortunately, this entity is diagnosed at an advanced stage in most patients, a fact that implies greater difficulty in its treatment and a worse prognosis. This systematic review aims to assess whether the cytokines IL-6, IL-8 and TNF-α are potential salivary biomarkers that allow early diagnosis of cancer.

MATERIAL AND METHODS

An electronic search was performed in three databases (Pubmed, Scopus and Web of Science). We used the following keywords: "salivary cytokines", "saliva cytokines", "salivary interleukins", "biomarkers", "oral squamous cell carcinoma" and "diagnosis", combined with the Boolean operators "AND" and "OR".

RESULTS

128 publications were found and finally 23 articles were included in the review and 15 in the meta-analysis. It has been observed that the majority of OSCC patients express higher salivary concentrations of IL-6, IL-8 and TNF-α compared to the control (CL) and premalignant lesion (OPML) groups. It has also been observed that the different premalignant lesions do not have statistically significant differences in the salivary concentration of the cytokines, and on the other hand, differences have been observed between the different TNM stages. The meta-analysis has shown that the difference in concentration of IL-6, IL-8 and TNF-α is statistically significant between the CL group and the OSCC, and also between the CL group and OPML.

CONCLUSIONS

There is sufficient evidence to affirm that IL-6, IL-8 and TNF-α are useful salivary cytokines in the early diagnosis and prognosis of OSCC. Although future studies are necessary to establish greater reliability of these biomarkers and thus be able to develop a valid diagnostic test.

Saliva biomarkers in oral disease

Saliva is a versatile biofluid that contains a wide variety of biomarkers reflecting both physiologic and pathophysiologic states. Saliva collection is noninvasive and highly applicable for tests requiring serial sampling. Furthermore, advances in test accuracy, sensitivity and precision for saliva has improved diagnostic performance as well as the identification of novel markers especially in oral disease processes. These include dental caries, periodontitis, oral squamous cell carcinoma (OSCC) and Sjögren's syndrome (SS). Numerous growth factors, enzymes, interleukins and cytokines have been identified and are the subject of much research investigation. This review highlights current procedures for successful determination of saliva biomarkers including preanalytical factors associated with sampling, storage and pretreatment as well as subsequent analysis. Moreover, it provides an overview of the diagnostic applications of these salivary biomarkers in common oral diseases.

Saliva as Biomarker for Oral and Chronic Degenerative Non-Communicable Diseases

Saliva is a very complex fluid and it is essential to maintain several physiological processes and functions, including oral health, taste, digestion and immunological defenses. Saliva composition and the oral microbiome can be influenced by several factors, like diet and smoking habits, and their alteration can represent an important access point for pathogens and, thus, for systemic illness onset. In this review, we explore the potentiality of saliva as a new tool for the early detection of some pathological conditions, such as oral diseases, chronic degenerative non-communicable diseases, among these chronic kidney disease (CKD). We also examined the possible correlation between oral and systemic diseases and oral and gut microbiota dysbiosis. In particular, we deeply analyzed the relationship between oral diseases and CKD. In this context, some salivary parameters can represent a new device to detect either oral or systemic pathologies. Moreover, the positive modulation of oral and gut microbiota induced by prebiotics, postbiotics, or symbiotics could represent a new possible adjuvant therapy in the clinical management of oral diseases and CKD.

Tumour Necrosis Factor Alpha (TNF-α) and Oral Squamous Cell Carcinoma

Uncovering the inflammatory mechanisms underpinning initiation, progression, and promotion of oral squamous cell carcinoma (OSCC) development is fundamental to the rational pursuit of targeted therapeutics. Here we present a review of the current knowledge of the role of TNF-α in the aetiology, pathogenesis, and potential therapies with regards to OSCC. TNF-α is worthy of particular attention in OSCC, with its presence demonstrated to enhance cell proliferation and its downregulation demonstrated to inhibit proliferation and migration in other carcinomas in both in vitro and in vivo models and oral cancer patients. Increased TNF-α in the OSCC tumour microenvironment has been demonstrated to favour invasion through promotion of firstly the pro-inflammatory, pro-invasive phenotypes of OSCC cells and secondly its paracrine mechanism mediating recruitment and activation of inflammatory cells. Polymorphisms affecting the gene expression of TNF-α have been strongly associated with an increased risk for oral squamous cell carcinoma. A number of studies have considered TNF-α within biofluids, including saliva and serum, as a potential biomarker for the early detection of OSCC, as well as its staging, differentiation, and prognosis. The broad and multifaceted role that TNF-α plays in many inflammatory states presents an obvious confounder, particularly with demonstrated increased TNF-α levels in common oral disease states. Lastly, biologic agents targeting TNF-α are currently in clinical use for immune-mediated inflammatory rheumatological and gastrointestinal diseases. There is the potential that these biological agents might have an adjunctive role in OSCC prevention and treatment.

A meta-analysis reveals the protein profile associated with malignant transformation of oral leukoplakia

The search for biomarkers associated with oral leukoplakia malignant transformation is critical for early diagnosis and improved prognosis of oral cancer patients. This systematic review and meta-analysis aimed to assess protein-based markers potentially associated with malignant transformation of oral leukoplakia. Five database and the grey literature were searched. In total, 142 studies were included for qualitative synthesis, where 173 proteins were investigated due to their potential role in malignant progression from oral leukoplakia (OL) to oral squamous cell carcinoma (OSCC). The abundance of these proteins was analyzed in fixed tissues and/or biofluid samples, mainly by immunohistochemistry and ELISA, and 12 were shared by both samples. Enrichment analysis revealed that the differential abundant proteins are mostly involved with regulation of cell death, regulation of cell proliferation, and regulation of apoptotic process. Also, these proteins are mainly expressed in the extracellular region (55.5%), cell surface (24.8%), and vesicles (49.1%). The meta-analysis revealed that the proteins related to tumor progression, PD-L1, Mdm2, and Mucin-4 were significantly associated with greater abundance in OSCC patients, with an Odds Ratio (OR) of 0.12 (95% CI: 0.04-0.40), 0.44 (95% CI: 0.24-0.81), and 0.18 (95% CI: 0.04-0.86), respectively, with a moderate certainty of evidence. The results indicate a set of proteins that have been investigated across OSCC initiation and progression, and whose transcriptional expression is associated with clinical characteristics relevant to the prognosis and aggressiveness. Further verification and validation of this biomarkers set are strongly recommended for future clinical application.

Effect of ethanol extract from Chrysanthemum cinerariifolium leaves on Ki-67 proliferation and dysplasia severity in a rat model of oral squamous cell carcinoma

Background

Oral squamous cell carcinoma (OSCC) is a malignant tumor that can rapidly infiltrate the oral epithelial tissue and cause high mortality worldwide because the available therapies are less effective. Chrysanthemum cinerariifolium leaf contains secondary metabolites as anti-inflammatory, antioxidant, anticancer, and antimutagenic.

Aims

The study aimed to analyze the ethanolic extract of C. cinerariifolium leaf in reducing proliferation (Ki-67) and the degree of dysplasia in OSCC rats.

Methods

This study used male Sprague Dawley induced by 7,12-dimethylbenz(a)anthracene (DMBA) 0.5% and divided into five treatment groups, namely positive control/C+ (sick), negative control/C- (healthy), and treatment group induced with DMBA and given extract C. cinerariifolium leaf with successive doses of T1, T2, and T3 (50, 100, and 200 mg/kg bw). The oral epithelium was stained with hematoxylin and eosin and immunohistochemically stained with a Ki-67 monoclonal antibody. The statistical analysis utilizes the one-way analysis of variance test.

Results

The results showed that T1 at a dose of 200 mg/kg bw could significantly reduce Ki-67 expression and the degree of oral epithelial dysplasia (OED; p < 0.05) close to healthy controls.

Conclusion

The conclusion shows that C. cinerariifolium leaf extract can be a therapy against OSCC by decreasing cell proliferation and the degree of OED.

Advances in the Diagnosis, Monitoring, and Progression of Oral Cancer through Saliva: An Update

The early detection of cancer, and in particular oral cancer, has been a priority objective of study in recent years. Saliva has been proposed as an easy-to-obtain means of providing the necessary information to diagnose malignant lesions in the oral cavity, since it can be obtained very easily and completely noninvasively. There are a number of molecules, known as biomarkers, which may be involved in the malignant transformation of oral lesions, and which have different natures. The involvement of proteins ("proteomics"), metabolites ("metabolomics"), and even certain genes in the structural changes of altered tissue has been investigated in order to establish validated parameters for the early diagnosis of oral cancer. In addition, the development of new analytical assay methods that can reduce costs and obtain better results in terms of sensitivity and specificity has been a key point in recent research in this field. Even though there are numerous biomarkers with results showing high sensitivity and specificity, there is still a need for more studies, with a larger sample and with analytical methods that can constitute a real advance in time and cost. Although salivary biomarkers are a promising new diagnostic tool for oral cancer, for the moment they do not replace biopsy as the "gold standard".

The New Era of Salivaomics in Dentistry: Frontiers and Facts in the Early Diagnosis and Prevention of Oral Diseases and Cancer

Nowadays, with the development of new and highly sensitive, blood is not the only medium of choice for the diagnosis of several diseases and pathological conditions. Saliva is now considered a safe and non-invasive sample to study oral and systemic diseases, showing great diagnostic potential. According to several recent studies, saliva has emerged as an emerging biofluid for the early diagnosis of several diseases, indicated as a mirror of oral and systemic health and a valuable source of clinically relevant information. Indeed, several studies have observed that saliva is useful for detecting and diagnosing malignant tumours, human immunodeficiency virus, heart disease, and autoimmune diseases. The growing realisation that saliva is an inexhaustible source of information has led to the coining of the term 'Salivaomics', which includes five "omics" in connection with the main constituents of saliva: genome and epigenome, transcriptomics, metabolomics, lipidomics, proteomics and microbiota. All those may be changed by disease state, so they offer significant advantages in the early diagnosis and prognosis of oral diseases. The aim of the present review isto update and highlight the new frontiers of salivaomics in diagnosing and managing oral disorders, such as periodontitis, premalignant disorders, and oral squamous cell carcinoma (OSCC).

Diagnostic Accuracy of Salivary Biomarkers in Detecting Early Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

BACKGROUND

Biopsy is the gold standard for oral squamous cell carcinoma (OSCC) diagnosis. Salivary biomarkers provide promising complementary alternative diagnostic adjunct for its simple non- invasive collection and technique and to screen large population.

OBJECTIVE

To summarize and compare the existing evidence on diagnostic accuracy of salivary biomarkers with their estimation method in detecting early oral squamous cell carcinoma.

METHODS

The review protocol is registered under PROSPERO(CRD42021225704). PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2020 to identify the screening potential of eight salivary biomarkers: mRNA, miRNA, DUSP100, s100P, IL-8, IL-1B, TNF-a and MMP-9. True-positive, false-positive, true-negative, false-negative, sensitivity, specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on QUADAS 2 tool. Meta-analysis was performed using a bivariate model parameter for the sensitivity and specificity and summary points, summary receiver operating curve (SROC), confidence region, and prediction region were calculated.

RESULTS

Eighteen studies were included for qualitative synthesis and out of that 13 for meta-analysis. Sensitivity and specificity were calculated with AUC. For mRNA it was 91% and 90% with 0.96 AUC, miRNA had 91% and 91% with 0.95 AUC for PCR. IL-1B had 46% and 60% with 0.61 AUC, S100p had 45% and 90% with 0.57 AUC for ELISA. IL-8 had 54% and 74% for ELISA and 89% and 90% for PCR with 0.79 AUC and DUSP1 had 32% and 87% for ELISA and 76% and 83% for PCR with 0.83 AUC respectively.

CONCLUSION

Early detection of OSCC was best achieved by screening for salivary mRNA and miRNA estimated by PCR. Further investigation is required into salivary RNA as novel biomarkers and these salivary biomarkers may be potentially used for non-invasive diagnosis of early OSCC.

Recognizing the salivary panomics for the clinical application in oral potentially malignant disorders

Oral cancer arises as a result of multistep carcinogenic progress from precursor lesion to oral squamous cell carcinoma through collective mutational process occur in the stem cells of mucosal epithelium. The detection of such oral potentially malignant disorders (OPMDs)/cancer in subclinical level will greatly improve the prognosis of a patient. The highly specific and sensitive salivary biomarkers have functioned in detection, prediction, surveillance and therapeutic monitoring of the diseases of interest. The aim of the review is to appraise various salivary biomarkers for the clinical utility in OPMDs. An electronic web-supported search was performed via PubMed, ScienceDirect and Google Scholar search engine since the year 2015–2019. A total of 28 research articles were selected for the review after screening and assessment. The various genomic, transcriptomic, proteomic, metabolomic and miscellaneous markers were analyzed and their characteristics and clinical application in OPMD patients were discussed. miR-21, miR-31, miR-84, H3F3A mRNA + IL-8P, matrix metalloproteinase-9, chemerin, tumor necrosis factor-alpha, cytokeratin-10, ornithine + O-hydroxybenzoate + R5F, 8-hydroxy-2-deoxyguanosine, malondialdehyde, Vitamin E and Vitamin C are identified as potential markers for OPMD patients. Scientifically validated, reliable and economical clinical biomarkers in OPMDs would serve as evidence-based treatment from patient point of view. Further longitudinal studies are needed to verify the accuracy and validate the applicability of these diagnostic/prognostic markers. Saliva has been reported as a valuable noninvasive valuable tool in biomarker identification. Recent advancements in salivary biomarker identification techniques lead to various potential biomarkers with precise outcome. The utilization of these biomarkers for the clinical application in OPMDs depends on the feasibility and personal choice of the clinician.

Salivary Cytokines as Biomarkers for Oral Squamous Cell Carcinoma: A Systematic Review

The prognosis of patients with oral squamous carcinoma (OSCC) largely depends on the stage at diagnosis, the 5-year survival rate being approximately 30% for advanced tumors. Early diagnosis, including the detection of lesions at risk for malignant transformation, is crucial for limiting the need for extensive surgery and for improving disease-free survival. Saliva has gained popularity as a readily available source of biomarkers (including cytokines) useful for diagnosing specific oral and systemic conditions. Particularly, the close interaction between oral dysplastic/neoplastic cells and saliva makes such fluid an ideal candidate for the development of non-invasive and highly accurate diagnostic tests. The present review has been designed to answer the question: "Is there evidence to support the role of specific salivary cytokines in the diagnosis of OSCC?" We retrieved 27 observational studies satisfying the inclusion and exclusion criteria. Among the most frequent cytokines investigated as candidates for OSCC biomarkers, IL-6, IL-8, TNF-α are present at higher concentration in the saliva of OSCC patients than in healthy controls and may therefore serve as basis for the development of rapid tests for early diagnosis of oral cancer.

GP88/PGRN Serum Levels Are Associated with Prognosis for Oral Squamous Cell Carcinoma Patients

Simple Summary

An oral squamous cell carcinoma (OSCC) is a tumor of the oral cavity that has a five-year survival rate of only around 50%. As this rate has not increased in recent decades, despite improvements in diagnosis and therapy, novel, easily accessible biomarkers for prognosis assessment are still needed. In our study, we measured the growth factor protein progranulin/GP88 in the serum of OSCC patients and demonstrated that an increased serum GP88 level is associated with a better prognosis for the OSCC patients in our study group. Furthermore, serum GP88 levels were not significantly associated with age, sex, or the tumor’s histological features, indicating that serum GP88 levels may be an independent predictor of an individual OSCC patient’s prognosis. These findings may help to improve therapy management of an OSCC in personalized medicine.

Abstract

Progranulin (PGRN)/GP88 is a growth factor that is expressed in a wide range of tumor tissues. The secreted form is involved in various biological processes including proliferation and inflammation. In several tumor types, the serum GP88 level is associated with a patient’s prognosis; however, data for oral squamous cell carcinomas (OSCCs) have not yet been reported. We measured the serum GP88 levels in 96 OSCC patients by an enzyme immunosorbent assay (EIA) and correlated these data with clinicopathological parameters and patient outcomes. The GP88 levels in the serum of OSCC patients and healthy volunteers were comparable. In OSCC patients, the levels did not correlate with age, sex, or TNM status. In a Kaplan–Meier survival analysis, a serum GP88 level < 68 ng/mL was significantly associated with worsened survival (p = 0.0005, log-rank-test) as well as in uni- and multivariate Cox regression analyses (RR = 4.6 [1.6–12.9], p = 0.004 and RR = 4.2 [1.2–12.0], p = 0.008). This effect was predominant in OSCC patients older than 60.5 years (p = 0.027), while in younger patients no significant association between serum GP88 levels and prognosis could be observed. Altogether, lower serum GP88 levels are significantly associated with a worsened outcome for an OSCC and may be an interesting candidate for risk stratification during OSCC therapy.

Salivary Biomarkers for Diagnosis and Therapy Monitoring in Patients with Heart Failure. A Systematic Review

The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.

Cytokines in saliva as biomarkers of oral and systemic oncological or infectious diseases: A systematic review

Recent evidence suggests that salivary cytokines provide information about both oral conditions and systemic diseases. This review summarizes evidence for the use of salivary cytokines as biomarkers for oral and systemic diseases. We included studies in adults and children with a focus on the latter, due to the importance of non-invasive diagnostic methods in the paediatric age group. A systematic review was performed using Medline and Web of Science covering the period of January 1996 to December 2019 according to the preferred reporting items for systematic reviews. Thirty-four studies were included in the final analysis, for a total of 2407 patients and healthy controls. Pro-inflammatory cytokines including interleukin (IL)-1β, IL-2, IL-6 and tumor necrosis factor (TNF)-α were associated with the severity of oral mucosal tissue damage in patients with cancer, and IL-1β may be an early marker of graft-versus-host disease. Salivary interferon-γ levels were correlated with oral complications and the presence of the underlying disease in HIV-infected individuals, and salivary cytokine patterns may be useful for diagnosing tuberculosis. In summary, current data illustrate that salivary cytokines are associated with oral inflammation, making them potential biomarkers for disease diagnosis and treatment efficacy. Because of the simplicity of saliva collection, this method may be useful in pediatric studies and in resource-limited settings.

The association of Candida and antifungal therapy with pro-inflammatory cytokines in oral leukoplakia

OBJECTIVES

To study the association of Candida and antifungal therapy with pro-inflammatory cytokines (PIC) in oral leukoplakia (OL).

MATERIALS AND METHODS

A prospective observational study where immunocompetent adult subjects with OL (30 homogenous (HL), 30 non-homogenous (NHL)) and 30 age and sex-matched healthy controls (C) with no predisposing factors for oral Candida infection were recruited. Sterile cotton swabs and ophthalmic sponges were used to sample the lesion surface in OL and buccal mucosa in C, for direct microscopy and culture for Candida and to determine levels of PIC (IL-6, IL-8. IL-17, TNF-α) by ELISA, respectively. Sampling for PIC was repeated at same sites in OL, 2 weeks after antifungal therapy.

RESULTS

Candida was associated with 55.3% of NHL, 23.3% of HL and 13.3% of C. The oral secretary levels of PIC were raised in NHL as compared to HL and C. The levels of IL-6, IL-8, TNF-α (p<0.001) and IL-17 (p<0.01) were significantly raised in Candida positive NHL while IL-6 (p<0.05) and TNF-α (p<0.01) were significantly raised in Candida positive HL before antifungal treatment. After antifungal treatment, there was significant reduction in PIC in Candida positive NHL and HL.

CONCLUSIONS

Candida infection contributes to the inflammatory milieu in Candida associated OL which increases the risk of carcinogenesis. Antifungal therapy reduces the PIC in Candida associated OL.

CLINICAL RELEVANCE

Identification and elimination of predisposing factors for Candida infection, like cessation of harmful habits, maintenance of oral/denture hygiene, surveillance for Candida and antifungal therapy at intervals, are recommended in OL.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04712929.

Looking beyond the smokescreen: can the oral microbiome be a tool or target in the management of tobacco-associated oral cancer?

A wide range of microbes inhabit the oral cavity, and bacterial and fungal communities most often exist as structured communities or biofilms. The use of tobacco alters the structure of the oral microbiome, including that of potentially malignant lesions, and the altered oral microbiome influences key microenvironmental changes such as chronic inflammation, secretion of carcinogenic toxins, cellular and tissue remodelling and suppression of apoptosis. Given this, it is clear that the bacterial and fungal biofilms in potentially malignant states are likely not passive entities, but could play a critical role in shaping potential malignant and carcinogenic conditions. This holds potential towards leveraging the oral microbiome for the management of tobacco-associated potentially malignant lesions and oral cancer. Here, we explore this line of investigation by reviewing the effects of tobacco in shaping the oral microbiome, and analyse the available evidence in the light of the microbiome of oral potentially malignant and cancerous lesions, and the role of dysbiosis in carcinogenesis. Finally, we discuss possible interventions and approaches using which the oral microbiome could be leveraged towards precision-based oral cancer therapeutics.

Animal model and bioinformatics analyses suggest the TIMP1/MMP9 axis as a potential biomarker in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is a common malignant tumor of the head and neck. However, the molecular mechanism underlying its development and progression is yet unclear. Genes that are differentially expressed, that is, differentially expressed genes (DEGs), between normal and diseased tissues are believed to be involved in disease development and progression. To identify the DEGs in OSCC and explore their role in occurrence and progression, we established a Chinese hamster OSCC model, determined the DEG, screened the identified DEGs, and performed Gene Ontology (GO) and KEGG enrichment analyses. A protein-protein interaction (PPI) network was generated to screen potential candidate genes. We then analyzed the expression, tumor stage and prognosis of candidate genes using the Gene Expression Profiling Interactive Analysis (GEPIA) database. Finally, we verified the candidate DEGs by quantitative real-time PCR and Gene Expression Omnibus analysis. The results showed 194 significantly DEGs, 140 enriched GO terms, and 8 KEGG pathways, which suggested that OSCC was closely related to the immune system, cell migration, and extracellular matrix. GEPIA and PPI network analysis revealed that SPP1, TNC, and ACTA1 were significantly related to tumor staging; SPP1, tissue inhibitors of matrix metallopeptidases (MMPs) 1 (TIMP1), and ACTA1 were closely related to prognosis. The scores for the top five highest degree genes were close, and the TIMP1/MMP9 axis appeared to be at the center of the PPI network, indicating that expression changes in the TIMP1/MMP9 axis and related genes may be involved in tumor invasion and metastasis. These findings provide novel insights into the mechanism of oral cancer.

Biosensors: A novel approach to and recent discovery in detection of cytokines

Cytokines in tissues and physiological fluids can function as potentially suitable biomarkers. Cytokines are involved in stimulating different body responses including inflammatory response to external pathogens, regulating cell-to-cell communication, and maintaining tissue homeostasis. Consequently, cytokines are extensively used to monitor and predict disease progression and to track the outcome of patient treatment. The critical diagnosis of cytokine and chemokine biomarkers has been the focus of attention and it has been continuously directing the trajectory of related research to developing a novel sensing platform. Given the major challenges and constraints of the older identification methods including their high costs, low sensitivity, and high specificity, the development of biosensor technology as a simple and inexpensive tool with high sensitivity is quite attractive and interesting. The fundamental aim of this study is to present the state-of-the-art biosensor systems in order to detect different types of cytokines and to emphasize the role of these systems in the prevention, monitoring, and treatment of various cytokine-associated diseases.

Salivary Markers in Relation to Oral Squamous Cell Carcinoma in Smokeless Tobacco Users: A Literature Review

Context: Nicotine and carcinogens are present in smokeless tobacco products. Oral, esophageal, and pancreatic cancers have been seen in Smokeless tobacco users. This article aims at reviewing the available literature and summarizing the application of salivary markers in smokeless tobacco users and their association with oral squamous cell carcinoma. Evidence Acquisition: The terms “saliva or salivary”, “markers or biomarkers”, “smokeless tobacco or Chewing tobacco or snuff”, and “oral cancer or oral carcinoma or oral squamous cell carcinoma” were searched in PubMed, MEDLINE, Google Scholar, and Google databases. Original and review English-written articles published over the past 20 years were reviewed, and the appropriate papers were chosen and intently studied. A data form designed by the author was used to write the proper results. Results: Our initial search identified 135 articles, 35 of which met the criteria for entering the final study and were contained for review. In summary, these studies described 20 markers found in the saliva of smokeless tobacco users linked to oral cancer. Conclusions: In this review study, some salivary markers such as cytokines, immunoglobulins, antioxidants, etc. were reviewed. In this review, it was shown that similar changes in these markers occur in patients with cancer and smokeless tobacco users. With the development of these diagnostic markers, these may be used as a screening tool for the early detection of cancer in smokeless tobacco users.

The Challenges of OSCC Diagnosis: Salivary Cytokines as Potential Biomarkers

Fast, economic, and noninvasive, molecular analysis of saliva has the potential to become a diagnostic tool of reference for several local and systemic diseases, oral cancer included. The diagnosis of Oral Squamous Cell Carcinoma (OSCC) can be performed using high specificity and sensibility biomarkers that can be encountered in the biological fluids. Recent advances in salivary proteomics have underlined the potential use of salivary biomarkers as early diagnosis screening tools for oral neoplasia. In this respect, over 100 salivary molecules have been described and proposed as oral cancer biomarkers, out of which cytokines are among the most promising. Besides being directly involved in inflammation and immune response, the role of salivary cytokines in tumor growth and progression linked them to the incidence of oral malignant lesions. This review summarizes the existing studies based on the use of salivary cytokines as potential oral cancer biomarkers, their involvement in the malignant process based on their type, and ther influence upon prognostic and metastatic rates.

Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies

Saliva is a highly versatile biological fluid that is easy to gather in a non-invasive manner—and the results of its analysis complement clinical and histopathological findings in the diagnosis of multiple diseases. The objective of this review was to offer an update on the contribution of salivary biomarkers to the diagnosis and prognosis of diseases of the oral cavity, including oral lichen planus, periodontitis, Sjögren’s syndrome, oral leukoplakia, peri-implantitis, and medication-related osteonecrosis of the jaw. Salivary biomarkers such as interleukins, growth factors, enzymes, and other biomolecules have proven useful in the diagnosis and follow-up of these diseases, facilitating the early evaluation of malignization risk and the monitoring of disease progression and response to treatment. However, further studies are required to identify new biomarkers and verify their reported role in the diagnosis and/or prognosis of oral diseases.

Salivary MMP-9 as a Biomarker for the Diagnosis of Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma

OBJECTIVE

To compare the salivary MMP - 9 concentration among subjects with oral squamous cell carcinoma (OSCC), oral potentially malignant disorders (OPMD), tobacco users, and control groups.

MATERIALS AND METHODS

A total of 88 subjects were enrolled and divided into four study groups viz., OSCC (n=24), OPMD (n=20), tobacco habits (n=22), and healthy controls (n=22). All subjects gave unstimulated saliva samples for the evaluation MMP - 9 by ELISA kit. Demographic information like age, gender, type of tobacco, and duration of the habit were recorded.

RESULTS

Subjects with OSCC and OPMD had significantly higher mean MMP-9 levels than subjects with tobacco habits and control groups (P<0.001). Also, poorly differentiated OSCC group had significantly higher mean saliva MMP-9 than moderate and well-differentiated OSCC. The optimal cut-off point was 214.37 ng/mL with a sensitivity of 100% and specificity of 59% for OSCC versus the control group. The optimal cut-off point was as 205.87 ng/mL with a sensitivity of 100% and a specificity of 54% for OPMD versus the control group.

CONCLUSION

The data obtained from this study indicated that OSCC and OPMD had an increased level of salivary MMP-9. Salivary MMP-9 could be a useful, non-invasive adjunct technique in the diagnosis, treatment, and follow-up of OSCC and OPMD. <br />.