It is essential to identify markers that could indicate the presence of early molecular changes in premalignant tissues like oral leukoplakia (OL). CD44 adhesion molecule is not only a stem cell marker, but also determines cell proliferation and migration in malignant processes. The aim of our study was to assess the amount and pattern of CD44 antigen expression by epithelial and mononuclear cells in the lamina propria under OL and their role in premalignant lesions. The current study included 102 cases of OL and ten biopsies from healthy oral mucosa. Immunohistochemical CD44 antigen expression was determined in 34 cases by a standard EnVision imaging system in three points of OL: both edges and centre. Statistical analysis was done using GraphPad Prism software version 8.4.0. In OL, statistically significant overexpression of membranous CD44 was demonstrated compared to healthy mucosa (p < 0.0001). The intra-cytoplasmatic CD44 expression of epithelium together with characteristic nuclear changes may be used as a predictive factor for potential malignant transformation of non-homogenous leukoplakia. CD44 expression in mononuclear cells under the basal membrane in OL (p < 0.05) possibly influences the process of premalignant lesion transformation into intraepithelial cancer. Further study of CD44 antigen expression in intra-cytoplasmatic structures is required for better explanation of the role of this glycoprotein.
The aim of this study was to determine whether and how pan-CD44 protein expression in leukoplakia tissues correlates with positive SolCD44 test presence and their role in oral leukoplakia. SolCD44 and total protein expression in saliva were determined using an OncAlert® Oral Cancer Rapid test. Comparison of paired associations of total protein, SolCD44, mean number of CD44 expressed epithelial layers in leukoplakia tissue, and macrophages below the basement membrane between control group and patients with leukoplakia showed statistically significant results (p < 0.0001). It is shown that the total protein indicates low or elevated risk of possible malignant transformation processes in leukoplakia. Statistically significant differences between higher total protein level and clinical forms of oral leukoplakia (p < 0.0001), as well as CD44-labeled epithelial cell layer decrease (p < 0.0001), were found. This possibly points to the onset of the stemness loss in leukoplakia tissue. CD9 antigen expression in the exosomes of the oral epithelium explained the intercellular flow of SolCD44 and other fluids in the leukoplakia area. We conclude that the OncAlert® Oral Cancer Rapid test is a valuable screening method in daily clinical practice, in terms of complementing clinical diagnostics methods and to assess the potential for early malignancy.
Dysregulation of the cell cycle is an important factor in a potentially malignant oral disorder. There have not been many studies on the role of the cell cycle regulator p27 in oral non-homogenous leukoplakia. The aim of our study was to characterise the p27 protein in homogenous and non-homogenous oral leukoplakias (OL), in comparison with healthy mucosa and squamous cell carcinoma tissues. The current study included 25 patients with OL, 15 cases with oral squamous cell carcinoma, and 15 samples of healthy oral mucosa, both as comparison groups. Immunohistochemical p27 antigen expression was determined by a standard EnView imaging system. The expression level of p27 in nodular and verrucous leukoplakia was lower than in homogenous OL but higher than in erythroleukoplakia. There was a statistically significant difference (p < 0.05) between the expression of p27 in healthy mucosa and homogenous OL. There was a significantly lower amount of p27 positive cells in oral cancer than in OL (p < 0.0001); however, its intracytoplasmic presence was diagnosed. Our study proved the instability of p27 protein and its dual nature in non-homogenous OL and OSCC, and therefore, it can be used as a predictive marker for the clinical course of these conditions.
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