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| ORIGINAL ARTICLE |
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Year : 2014? |? Volume : 3? |? Issue : 1? |? Page : 17-20 |
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Status of salivary iron in oral cancer and oral potentially malignant disorders
Shishir Ram Shetty1, Subhas Babu1, Suchetha Kumari2, Pushparaja Shetty3, Shruthi Hegde1, Renita Castelino1
1?Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Science, Nitte University, Mangalore, Karnataka, India
2?Department of Biochemistry, KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
3?Department of Oral Pathology, AB Shetty Memorial Institute of Dental Science, Nitte University, Mangalore, Karnataka, India
| Date of Submission |
29-Oct-2013 |
| Date of Acceptance |
07-Mar-2014 |
| Date of Web Publication |
11-Apr-2014 |
Correspondence Address:
Shishir Ram Shetty
Reader, Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte University
India
DOI: 10.4103/2278-9588.130432
Introduction: Iron (Fe) is an important micronutrient which is utilized in human body for the transportation of oxygen, hematopoiesis, production of enzymes, and immune surveillance. Existing clinical, epidemiological, and experimental studies have shown that decreased levels of Fe contribute to increased risk of cancer. Although extensive, serum Fe analysis studies have done recently the analysis of salivary Fe has not been studied for its role in oral malignancies.
Materials and Methods: Salivary Fe levels were evaluated in 65 healthy controls (HC), 115 subjects with oral potentially malignant disorders, and 50 subjects with oral squamous cell carcinoma using the bathophenanthroline method.
Results: A decrease in the levels of salivary Fe was observed in subjects with potentially malignant disorders and subjects with oral cancer. The decrease in the salivary Fe was significant (P = 0.05) in group comprising of potentially malignant disorders and oral squamous cell carcinoma when compared to HC.
Conclusion: The significant and encouraging findings of the present study thus validate and reinforce that; salivary Fe analysis can be used as an efficient, noninvasive, patient-friendly tool for the early diagnosis of oral potentially malignant disorders and oral squamous cell carcinoma for planning comprehensive treatment protocol.
Keywords:?Iron, oral leukoplakia, oral squamous cell carcinoma, saliva
How to cite this article:
Shetty SR, Babu S, Kumari S, Shetty P, Hegde S, Castelino R. Status of salivary iron in oral cancer and oral potentially malignant disorders. J Cranio Max Dis 2014;3:17-20 |
How to cite this URL:
Shetty SR, Babu S, Kumari S, Shetty P, Hegde S, Castelino R. Status of salivary iron in oral cancer and oral potentially malignant disorders. J Cranio Max Dis [serial online] 2014 [cited?2014 Sep 7];3:17-20. Available from:?https://craniomaxillary.com/text.asp?2014/3/1/17/130432 |
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??Introduction |
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Studies have shown alterations in iron (Fe) indices and parameters such as serum Fe and hemoglobin strongly attributed to utilization of Fe by bone marrow and rapidly growing tumors. [1] Many researchers believe that oral submucous fibrosis (OSMF) may be the manifestation of chronic Fe deficiency, anemia and a counterpart of ?Plummer-Vinson syndrome?More Details in eastern countries. [2] Utilization of Fe in collagen synthesis by the hydroxylation of proline and lysine leads to decreased serum Fe levels in OSMF patients. [3] Although there have been several studies evaluating the serum Fe indices in oral cancer and precancer, salivary Fe levels have seldom been evaluated. With this background we evaluated the levels of salivary Fe in subjects with oral potentially malignant disorders and oral squamous cell carcinoma.
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??Materials and Methods |
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A cross-sectional study was conducted involving 230 subjects in the age group of 20-60 years reporting to the Department of Oral Medicine and Radiology. The control group consisted of 65 healthy controls (Group HC). Group PMD consisted of 115 patients with oral potentially malignant disorders (PMD; this comprised 65 cases of OSMF and 50 patients of oral leukoplakia). Group OSCC consisted of 50 oral squamous cell carcinoma patients (OSCC). Group HC was divided into two subgroups: HC1 which consisted of HC without quid chewing and/or smoking habits HC2 which consisted of HC with quid chewing and/or smoking habits. Patients with systemic illness, long-term drug intake, previous history of malignancy, or history of antioxidant medication. Unstimulated saliva was collected from the study subjects between 9:00 am and 12:00 pm to avoid diurnal variation. The subjects were requested not to eat, drink, perform oral hygiene activities, or chew 60 min prior to the saliva collection procedure. The subjects were then seated on the dental chair and asked to spit in a graduated container every 1 min till 5 ml of saliva was obtained. During saliva collection, subjects were instructed not to speak or swallow. The salivary samples were stored at a temperature of-20?C. Estimation of Fe was carried out by bathophenanthroline method. A 100 ?L of the saliva sample was taken in a clean microfuge tube and made up to 250 ?L with the addition of deionized water and 500 ?L of protein precipitating solution was added to the diluted sample. The mixture was then centrifuged at 2,000 rpm for 10 min and 500 ?L of the supernatant was taken and added to 500 ?L of chromogen solution (25 mg bathophenanthroline sulfonate dissolved in 100 mL of sodium acetate (2 M). The optical density of the pink color formed was read immediately (within 10 min) at 535 nm against a blank, treated in a similar method as the test, wherein the sample was replaced with deionized water. The concentration of Fe in the sample was obtained by plotting the optical densities of the test against the standard graph. The concentration obtained was then multiplied by the dilution factor (2.5). Statistical analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 17 software. Scheffe's test was used in conjunction with analysis of variance (ANOVA) for comparison between multiple unequal groups.
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??Results |
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The mean salivary Fe levels of group HC1 was 76.21 ? 7.97 ?g/dL and group HC2 was 72.45 ? 7.11 ?g/dL. The mean salivary Fe levels of group Oral Leukoplakia (OL) was 52.81 ? 8.11 ?g/dL and group OSMF was 35.96 ? 11.31 ?g/dL, respectively. The mean salivary Fe levels of group OSCC was 33.87 ? 8.17 ?g/dL. When the mean salivary Fe levels of group HC1, PMD, and OSCC were compared, a significant difference existed between the mean salivary Fe levels of group HC1 and PMD (P = 0.01). Similarly, there was a statistically significant difference when group HC1 and OSCC were compared (P = 0.01). The mean salivary Fe levels of group OSCC was lower than the mean salivary Fe levels of group PMD (P = 0.01) [Table 1] and [Table 2]. Further when the mean salivary Fe levels of group HC1 were compared to group HC2, the mean salivary levels of Fe was found to be lower in group HC2, but not statistically significant (P = 0.1) [Table 3]. Mean salivary Fe levels of group OSMF was significantly lower than group OL (P = 0.01) [Table 4].
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Table 1: Comparison of the salivary iron (Fe) levels in the study groups
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Table 2: Pairwise comparison of salivary iron (Fe) levels in the study groups
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Table 3: Comparison of the salivary iron (Fe) levels between the study groups HC1 and HC2
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Table 4: Comparison of the salivary iron (Fe) levels between the study groups OL and OSMF
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??Discussion |
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Fe is an essential element for the human body that enables a number of highly complex processes like the transportation of oxygen, hematopoiesis, production of enzymes, and immune surveillance.
Several existing clinical, epidemiological, and experimental studies have shown that decreased levels of Fe contributes to increased cancer risk through the impairment of several Fe-dependent metabolic functions that are related to genome protection and maintenance like immune responses against cancer-initiated cells, metabolism of toxic compounds, and redox regulation of DNA biosynthesis and repair. [4]
In our study, we found that the salivary Fe levels were significantly reduced in group OSMF when compared to group HC1, which is consistent with a recent south Indian study where they found a decrease in the levels of serum Fe in OSMF patients when compared to controls. [5] In one recent study, it has been observed that serum hemoglobin and Fe levels were lower in patients with OSMF when compared with HC. Further, they observed a significant reduction in serum Fe levels in OSMF patients, when on comparison with anemic patients. Few researchers have observed a decrease in the serum Fe levels in OSMF group when compared to HC. [5],[6] They attributed the reason for the decrease to the involvement of Fe in the stimulation of collagen synthesis in OSMF subjects. Collagen consists of proline and lysine, which are hydroxylated by prolyl hydoxylase (PH) and lysyl hydroxylase (LH) with cofactors such as Fe and Ascorbic Acid (AA). Experimental evidence has proved that Fe is the most effective cofactor for PH protein expression, followed by AA which is the second best cofactor for PH protein expression. [7] Besides Fe being utilized in the collagen synthesis, another reason for depletion in Fe and essential nutrients could be due to the pronounced difficulty in mastication caused by initial ulceration which is associated with OSMF.
In the present study, we found a significant decrease in the salivary Fe in group OSCC when compared to group HC1, which is in accordance with a serum study where they observed a decrease in Fe and selenium concentrations in oral cancer patients when compared to controls. [8]
The reason for the depletion of Fe could be multifactorial. Factors such as altered epithelial cell turnover rate and tumor cell proliferation leads to the depletion of Fe levels and the reserve body Fe stores. Further, reduction in Fe indices occurs due to difficulty in consumption of normal diet, thereby leading to poor nutrition.
In a pioneering study on salivary Fe levels in anemic children, revealed that salivary Fe correlates well with serum Fe and stated that a decrease in the salivary Fe levels indicated a severe depletion in body Fe stores. [9] So the above study underlines the importance of salivary Fe estimation in systemic diseases, and thereby lends support for the estimation of salivary Fe analysis in PMD and OSCC. Thus, in the present study we observed that the salivary Fe levels decreased in group PMD and group OSCC when compared to group HC1. This decrease in the salivary Fe level could be predominantly due to reduced Fe absorption owing to alterations in dietary factors rather than secretion of Fe from the salivary gland itself. Therefore, it can be stated that extensive and broad-based salivary Fe studies needs to be undertaken for better understanding of its role in oral carcinogenesis.
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? [Table 1], [Table 2], [Table 3], [Table 4]
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