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

OXIDATIVE STRESS AND ANTIOXIDANT MARKERS IN ORAL SUBMUCOUS FIBROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CASE-CONTROL STUDIES

OBJECTIVE

This meta-analysis systematically investigates the markers of oxidative stress (OS) and antioxidant systems in the saliva and serum of patients with oral submucous fibrosis (OSF) and healthy controls.

METHODS

Using a comprehensive search of databases from their inception period to December 31, 2023, articles related to OS or antioxidant markers in patients with OSF and healthy controls were retrieved. Literature screening and data extraction were performed by two reviewers according to the set criteria, and a third evaluator was involved in case of disagreements. The included studies were assessed with the Newcastle-Ottawa Scale, and the results were analyzed using Review Manager 5.4 software.

RESULTS

A total of 14 studies were included. Patients with OSF exhibited significantly higher levels of malondialdehyde (serum: SMD: 7.65, 95% confidence interval [CI]: 5.14-10.17, P < .00001, saliva: SMD: 3.07, 95% CI: 0.6-5.54, P < .00001) and 8-hydroxy-deoxyguanosine (saliva: SMD: 4.84, 95% CI: 3.49-6.18, P < .00001) than healthy controls. Levels of vitamin C (serum: SMD: -3.54, 95% CI: -4.10 to -2.99, P < .00001, saliva: SMD: -1.10, 95% CI: -1.39 to -0.80, P < .00001), vitamin E (saliva: SMD: -1.78, 95% CI: -2.1 to -1.45, P < .00001), and superoxide dismutase (serum: SMD: -9.77, 95% CI: -13.79 to -5.74, P < .00001) were significantly lower in patients with OSF than in healthy controls.

CONCLUSIONS

The results showed increased levels of OS markers and decreased levels of antioxidant markers in patients with OSF, providing valuable indicators that may aid in clinical diagnosis and management.

Alteration of salivary LPO, MDA, LDH, glutathione, GPx, SOD and vitamins in oral submucous fibrosis: A three-level meta-analysis study

This study aims to investigate the alteration of salivary biomarker profiling in the development of oral submucous fibrosis (OSMF) and to explore the influence of saliva in the diagnosis of OSMF. A systematic search of published articles using the PRISMA guidelines was conducted to identify relevant studies on OSMF and saliva. All eligible studies, including case-control, cross-sectional studies, cohort, and pilot studies, contained the evaluation of salivary biomarker profiling in patients with OSMF. Salivary biomarker data from 28 selected articles were categorized into nine groups, and their mean values were determined. A three-step meta-analysis was performed by grouping salivary biomarker profiling into more heterogeneous categories based on OSMF classification, considering functional, histological, and clinical grading. The salivary biomarker profiling analysis revealed significant alterations in all markers, indicating their efficacy in OSMF diagnosis. Subgroup analyses highlighted significant associations in oxidative stress and protein with increased mean values, particularly emphasizing lipid peroxidase (LPO), malondialdehyde (MDA), and lactate dehydrogenase (LDH). Conversely, decreased mean values were observed in glutathione, glutathione peroxidase (GPx), superoxide dismutase (SOD), and vitamins. Notably, OSMF grading analysis demonstrated a significant difference in weighted effect sizes for histological grading, particularly in stage IV. The study underscores the alteration of specific salivary biomarkers, particularly those associated with LPO, MDA, LDH, glutathione, GPx, SOD, and vitamins, in diagnosing and grading OSMF.

Computational analysis of phytocompounds in Centella asiatica for its antifibrotic and drug-likeness properties - Herb to drug study

Oral submucous fibrosis (OSMF) is a potentially malignant disorder with no permanent cure that affects the quality of life due to trismus. Computational pharmacology has accelerated the discovery of drug candidates for the treatment of incurable diseases. The present study aimed to screen the compounds of the miracle herb Centella asiatica with drug-likeness properties based on the absorption, distribution, metabolism, and excretion (ADME) properties. The pharmacological actions of these screened compounds against OSMF were identified by network pharmacology, gene ontology, pathway enrichment analysis, molecular docking, and simulation. Fifteen drug-like ligands were identified after virtual screening viz; asiatic acid, kaempferol, quercetin, luteolin, apigenin, bayogenin, gallic acid, isothankunic acid, madecassic acid, madasiatic acid, arjunolic acid, terminolic acid, catechin, epicatechin, and nobiletin. 850 potential targets were predicted for the ligands, which were analyzed against 354 proteins associated with OSMF. Compound pathway analysis and disease pathway analysis identified 53 common proteins. The GO enrichment analysis identified 472 biological process terms, 76 molecular function terms, and 44 cellular component terms. Pathway enrichment analysis predicted 142 KEGG pathways, 35 Biocarta pathways, and 236 Reactome pathways for the target proteins. The analysis revealed that the herb targets crucial events of fibrosis such as inflammation, oxidative stress, apoptosis, collagen deposition, and epithelial-mesenchymal transition. The common 53 proteins were used for protein-protein interaction (PPI) network analysis, which revealed 4 key proteins interacting with the phytocompounds viz; transforming growth factor-β1 (TGF-β1), mothers against decapentaplegic-3 (SMAD-3), mitogen-activated protein kinase-1 (MAPK-1) and proto-oncogene tyrosine-protein kinase (SRC). Molecular docking revealed that all ligands had a good binding affinity to the target proteins. Bayogenin had the highest binding affinity towards MAPK-1 (-9.7 kcal/mol), followed by isothankunic acid towards SRC protein (-9.3 kcal/mol). Madasiatic acid had the highest binding affinity to SMAD-3 (-7.6 kcal/mol) and TGF-β1 (-7.1 kcal/mol). Molecular dynamics simulation demonstrated stable ligand protein interactions of bayogenin and MAPK complex, isothankunic acid and SRC complex. This in silico study is the first to identify potential phytochemicals present in Centella asiatica and their target molecules, which might be responsible for reversing OSMF.

Development of Epigallocatechin 3-gallate-Loaded Hydrogel Nanocomposites for Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) is a chronic progressive disease associated with increased collagen deposition and TGF-β1 release. The current therapy and management have been a limited success due to low efficacy and adverse drug reactions. This study aimed to evaluate epigallocatechin 3-gallate (EGCG) encapsulated nanoparticles loaded mucoadhesive hydrogel nanocomposite (HNC) for OSF. Developed HNC formulations were evaluated for their permeation behaviour using in vitro as well as ex vivo studies, followed by evaluation of efficacy and safety by in vivo studies using areca nut extract-induced OSF in rats. The disease condition in OSF-induced rats was assessed by mouth-opening and biochemical markers. The optimized polymeric nanoparticles exhibited the required particle size (162.93 ± 13.81 nm), positive zeta potential (22.50 ± 2.94 mV) with better mucoadhesive strength (0.40 ± 0.002 N), and faster permeation due to interactions of the positively charged surface with the negatively charged buccal mucosal membrane. HNC significantly improved disease conditions by reducing TGF-β1 and collagen concentration without showing toxicity and reverting the fibroid buccal mucosa to normal. Hence, the optimized formulation can be further tested to develop a clinically alternate therapeutic strategy for OSF.

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.

Mechanisms and markers of malignant transformation of oral submucous fibrosis

Oral submucous fibrosis (OSF) is a chronic premalignant disease associated with betel quid chewing. Epidemiological studies indicate that there are approximately 5 million individuals suffering from OSF worldwide, with a concerning malignancy transformation rate of up to 4.2 %. When OSF progresses to oral squamous cell carcinoma (OSCC), the 5-year survival rate for OSCC drops to below 60 %. Therefore, early screening and diagnosis are essential for both preventing and effectively treating OSF and its potential malignant transformation. Numerous studies have shown that the malignant transformation of OSF is associated with various factors, including epigenetic reprogramming, epithelial-mesenchymal transition, hypoxia, cell cycle changes, immune regulation disturbances, and oxidative damage. This review article focuses on the unraveling the potential mechanisms underlying the malignant transformation of OSF, as well as the abnormal expression of biomarkers throughout this transformative process, with the aim of aiding early screening for carcinogenic changes in OSF. Furthermore, we discuss the significance of utilizing blood and saliva components from patients with OSF, along with optical diagnostic techniques, in the early screening of OSF malignant transformation.

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.

A biochemical research focused on the association of the levels of oxidative stress and nitric oxide with premalignant disorders and oral squamous cell carcinoma

CONTEXT

The reactive oxygen species such as superoxide radicals (O2 •), hydroxyl radicals (OH•), and hydrogen peroxide play a vital role in the pathogenesis of human cancer development and have become one of the areas of key interest in the field of biochemical analysis.

AIMS

The present study was designed to determine the significance of oxidative stress and levels of nitric oxide (NO) in patients with premalignant disorders and oral squamous cell carcinoma (OSCC), by evaluating the levels of lipid peroxidation products, antioxidants, and NO products.

SETTINGS AND DESIGN

The present study was conducted on 280 patients for 2 years. These patients were divided into 4 groups, Group I (n = 70, control), Group II (n = 70, oral submucous fibrosis), Group III (n = 70, OSCC), and Group IV (n = 70, OL).

SUBJECTS AND METHODS

The levels of lipid peroxidation products, antioxidants, and NO products were determined by colorimetric methods.

STATISTICAL ANALYSIS USED

Paired t-test was used to compare the mean.

RESULTS

Lipid peroxidation products such as lipid hydroperoxide and malondialdehyde and NO products such as nitrite (NO2-), nitrate (NO3-), and total nitrite (TNO2-) were significantly elevated, whereas enzymatic and nonenzymatic antioxidants were significantly lowered in OSCC, oral submucous fibrosis, and oral leukoplakia when compared to normal healthy participants. The P values were calculated and came as statistically significant (<0.05).

CONCLUSIONS

Antioxidant enzyme impairment and NO status may be considered as one of the factors responsible for oral cancer pathogenesis and may serve as a promising biomarker and therapeutic target for minimizing malignant transformation in oral premalignant disorders.

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.

Plasma secretome analyses identify IL-8 and nitrites as predictors of poor prognosis in nasopharyngeal carcinoma patients

Predicting tumor recurrence and death in patients with nasopharyngeal carcinoma (NPC) remains to date challenging. We here analyzed the plasmatic secretomes of NPC untreated and relapsing patients, and explored possible correlations with the clinical and pathological features and survival characteristics of the corresponding patient cohorts, with the aim of identifying novel prognostic biomarkers. This study included 27 controls, 45 untreated NPC and 11 relapsed patients. A set of 14 plasma cytokines were analyzed using Millipore multiplex assay. Nitrites were assessed by Griess method. A comparative analysis of each groups' secretome showed upregulation of IL-8, IL-12p70, IL-10 and IP-10 in untreated patients, and of IL-6, IL-10, MCP-1 and IP-10 in relapsing patients. Nitrites significantly correlated with IL-8 during relapse. Secretomes' network analyses revealed prevalence of high correlations between IL8/IL-17A and IFN-γ/IL12p70 in the control group, between TNF-α/IL-8/IL-6, TNF-α/VEGF/IFN-γ and IL-10/MCP-1 in the untreated group, and between IL-8/IL-6/IL-10, TNF-α/IL-8/IL-6, IL12-p70/VEGF/IL-10/IFN-γ, IL-6/IL-10/IFN-γ and IL-8/IP-10 in the relapse group. IL-12p70, IP-10 and MCP-1 levels respectively associated with gender, age and node metastasis respectively. Recurrence-free survival (RFS) analysis showed that patients presenting High IL-8/Low NO immunological scores presented a combined 80% probability of relapse/death after 53 months (combined log-rank test p = 0.0034; individual p = 0.012 and p = 0.016). Multivariate Cox hazard regression analysis revealed that IL-8 (HR = 7.451; 95% CI [2.398-23.152]; p = 0.001) and treatment type (HR = 0.232; 95% CI 0.072-0.749; p = 0.015) were independent prognostic factors. C&RT decision tree analysis showed that High IL-8/Low NO immunological scores predicted treatment failure in 50% cases starting the 36th month of follow-up (AUC = 1) for all of the studied cases and in 57% cases for patients receiving chemotherapy alone (AUC = 1). Altogether, our results showed that NPC development is accompanied with cytokines deregulation to form specific interaction networks at time of diagnosis and relapse, and demonstrate that High IL-8/Low NO signature may constitute a predictor of poor prognosis which may be useful to improve risk stratification and therapy failure management.

A Comprehensive Analysis of the Role of Oxidative Stress in the Pathogenesis and Chemoprevention of Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is a chronic oral potentially malignant disorder (OPMD). It is described as a scarring disease of the oral mucosa associated with excess oxidants and insufficient antioxidants. While it is becoming increasingly accepted that oxidative stress results in excessive accumulation of collagen and progressive fibrosis of the submucosal tissues, there is limited data regarding the moderation of oxidative stress to initiate or prevent OSMF. To assess the scope for mechanism-based approaches to prevent or reverse OSMF, we systematically evaluated the existing literature and investigated the role of oxidative stress in the pathogenesis and chemoprevention of OSMF. A search for relevant articles on PubMed and Scopus was undertaken using pre-defined inclusion and exclusion criteria. A total of 78 articles were selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The articles eligible for assessment investigated both OSMF and/or oxidative stress biomarkers or specific antioxidants. Both in vitro and human studies consistently demonstrated variations in oxidative stress biomarker levels in OSMF and revealed an increase in oxidative stress, paralleling the development of the disease. Furthermore, the use of antioxidant supplements was overall associated with an improvement in clinical outcomes. Having identified the significance of oxidative stress in OSMF and the therapeutic potential of antioxidant supplements, this scoping review highlights the need for further well-designed studies in the development of mechanism-based interventions for managing OSMF.

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.