Estimation of Salivary Immunoglobulins and Acute Phase Proteins in Patients with Potentially Malignant Disorders, Oral Cancer and Treated Oral Cancer

The present study titled “Estimation of salivary immunoglobulins and acute phase proteins in patients with Potentially malignant disorders, Oral Cancer and Treated oral cancer” was conducted in the department of Oral Medicine and Radiology, Ragas Dental College, Uthandi, Chennai and Dr. Rai Memorial Medical and Cancer Centre, Chennai, to estimate the salivary levels of IgA, IgG, C-reactive protein and Haptoglobin in patients with potentially malignant disorders like leukoplakia and oral submucous fibrosis, oral cancer and treated oral cancer and to compare the values with the control subjects. A total of 80 individuals were selected for the study. Among the study subjects 20 patients were suffering from Potentially Malignant Disorders, 20 patients were suffering from Oral Cancer, 20 were treated for Oral Carcinoma and 20 patients were normal controls. Informed consent was taken from all subjects before including them in the study. Participants with infectious diseases during one month before saliva sampling, active dental abcesses, and collagen vascular diseases were excluded from the study. The experimental subjects were made to sit comfortably on a Dental Chair. Sterile hand gloves were used during examination of the patients. Patients were examined under halogen lamp in the dental chair under aseptic conditions and relevant demographic data were collected. Clinical diagnosis was made and patients who showed characteristic features of Leukoplakia, Oral submucous fibrosis and Oral Cancer were prepared for sample collection. The patients were asked to rinse their mouth with water and were made to sit comfortably in a dental chair. Saliva was collected during a 15-minutes interval by spitting method. This was pooled saliva and represented the output from all the salivary glands. 2-3mL of saliva was collected in sterile containers. All samples were kept in ice after collection and then centrifuged at 3000 rpm for 10 min to remove particulate materials and the supernatant was used for estimation of the immunoglobulins and acute phase proteins. The study documents the following data: 1. Among the 80 subjects 62 (77.5%) were males and 18 (22.5%) were females. The minimum age of the study subjects was 19 years and the maximum age was 75 years. 2. Among the 80 subjects 20 (25%) had the habit of smoking, 23 (28.8%) had the habit of chewing, 12 (15%) had the habit of chewing and smoking, 10 (12.5%) had the habit of smoking and alcohol consumption, 1 (1.3%) had the habit of chewing and alcohol consumption and 3 (3.8%) had all the three habits together with a p value of 0.000 which is statistically significant. Thus a positive correlation between smoking, chewing, alcohol consumption and development of precancer and cancer has been established. 3. The most common site for leukoplakia was in the retro-commissure area with 7 (63.6%) subjects followed by buccal mucosa 2(18.2%) and one each in the tongue and floor of the mouth. 4. The present study showed all 9 cases of OSMF in the buccal mucosa with 5 (55.6%) in Grade III and 2 each in Grades I and IV and none in Grade II. 5. Among the total of 40 (100%) subjects in Groups II and III, 11 (27.5%) had carcinoma in the tongue, 17 (42.5%) had in the buccal mucosa, 7 (17.5%) had in the alveolar mucosa, 2(5%) had carcinoma in the floor of the mouth and 1 (2.5%) in the palate and 2 (5%) had in both the tongue and the floor of the mouth. 6. Elevated levels of salivary IgA, IgG, CRP and Haptoglobin were observed in patients with potentially malignant disorders like leukoplakia and oral submucous fibrosis. The mean salivary IgA in patients with potentially malignant disorders was 201.7 ± 76.01 μg/mL, the mean salivary IgG was 8.7± 4.07 μg/dL, mean salivary CRP was 0.015± 0.036 μg/mL and the mean salivary haptoglobin was 1.43 ± 0.843 mg/dL. In controls the mean salivary IgA was 72.87 ± 26.46 μg/mL, the mean salivary IgG 6.58 ± 5.60 μg/dL, the mean salivary CRP was 0.070 ± 0.13 mg/L and the mean salivary haptoglobin was 1.91 ± 0.895 mg/dL. 7. There was a significant rise in the salivary IgA, IgG, and Haptoglobin and a slight elevation in the salivary CRP levels in patients with oral carcinoma. The mean salivary IgA in patients with oral carcinoma was 253.35 ± 83.3μg/mL, the mean salivary IgG was 33.86 ± 20.31mg/dL, mean salivary CRP was 0.050 ± 0.10 μg/mL and the mean salivary haptoglobin was 4.56 ± 1.19mg/dL. In controls the mean salivary IgA was 72.87 ± 26.46 μg/mL, the mean salivary IgG 6.58 ± 5.60 μg/dL, the mean salivary CRP was 0.070 ± 0.13 mg/L and the mean salivary haptoglobin was 1.91 ± 0.895 mg/dL. 8. The salivary IgA, IgG and CRP in treated oral cancer patients remained significantly higher. The mean salivary IgA in patients with treated oral carcinoma was 76.26 ± 9.20 μg/mL, the mean salivary IgG was 17.74 ± 3.12 μg/dL and the mean salivary CRP was 0.120 ± 0.128mg/L. In controls the mean salivary IgA was 72.87 ± 26.46 μg/mL, the mean salivary IgG 6.58 ± 5.60 μg/dL and the mean salivary CRP was 0.070 ± 0.13 mg/L. 9. A significant decrease in the salivary haptoglobin levels were observed in treated oral cancer patients. The mean salivary haptoglobin in treated oral cancer patients was 1.285 ± 0.492 mg/dL and the mean salivary haptoglobin in controls was 1.91 ± 0.895 mg/dL. Thus the salivary IgA was found to be highest in patients with oral carcinoma followed by patients with potentially malignant disorders, then treated oral cancer patients and the controls having the lowest values. The salivary IgG was found to be highest in patients with oral carcinoma followed by patients treated for oral carcinoma, patients with potentially malignant disorders and lowest in the controls. The salivary CRP was highest in the patients treated for oral carcinoma followed by controls, patients with oral carcinoma and lowest in patients with potentially malignant disorders. The salivary haptoglobin was highest in oral carcinoma patients followed by controls, patients with potentially malignant disorders and lowest in patients treated for oral carcinoma. The increase of these salivary immunoglobulins and acute phase proteins in precancerous lesions and oral carcinoma may reflect the local inflammation accompanying the neoplastic process in the oral cavity or due to the direct transudation of these proteins from the blood or may be considered as a local defense mechanism against tumour development. To conclude, a statistically significant difference was observed in relation to the tested parameters between the four different groups included in the study. Salivary analysis holds promise as a noninvasive approach to identify biomarkers for human oral cancer. An extensive, well-executed study is required to ensure the practical usefulness of these biomarkers in screening for early oral cancer, possible recurrent disease and individuals with high risk of oral malignancy. Further studies should include a larger sample size to emphasize the sensitivity and specificity of these biomarkers so as to arrive at an early diagnosis aimed at the betterment of the patients.