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Lactate Dehydrogenase As A Biomarker In Oral Cancer And Oral Submucous Fibrosis
Kallalli B, Rawson K, Muzammil, Singh A, Awati M, Shivhare P. J Oral Pathol Med (2016)
Introduction:
Oral squamous cell carcinoma is the sixth most
common cancer among all the cancers. The
annual incidence rate of oral cancer is about 275
000 and 128 000 deaths annually.
Most Common Causative factors
Tobacco and its products:
Biological markers for cancer detection are
frequently detected in serum, urine, saliva,
cerebrospinal fluid, etc.
Lactate dehydrogenase (LDH) is one among
such biomarkers. LDH is found in almost all the
body cells. LDH catalyzes the final step in the
metabolic chain of anaerobic glycolysis. LDH
levels have been shown to elevate in several
potentially malignant lesions/conditions and in
oral cancer . There are several studies
performed to estimate the LDH levels in serum
while its estimation in saliva is currently being
explored.
Hence, we chose to perform this study to
estimate the levels of LDH in saliva in the
patients with OSMF and oral cancer.
Aim And Objectives:
The estimation of LDH levels in saliva as diagnostic markers, using a non-invasive method in patients with
OSMF, oral cancer, and in the controls.
Statistical Analysis: paired t-test using SPSS
Materials and Method:
software version 22. P-value < 0.05- was taken
A total of 60 subjects with the age range of 20–70
as significant.
years were selected.
Results
Group I: OSMF (n=25)
The P- value obtained was 0.0009, which was
Group II: OSCC (n=25)
highly significant for Groups I and II, indicating
Group III: Normal Controls (n=10)
that the salivary LDH levels in Groups I and II
Exclusion criteria: immune- compromised, infectious
were higher than that of Group III
diseases, pulmonary diseases, endocrine disorders,
coronary artery disease, renal disease, hepatic
disease, and patients under corticosteroid therapy.
5ml unstimulated, whole saliva– centrifuged—ERBA
Chem semi auto analyzer. Values obtained were
statistically analyzed.
Discussion:
WHO defined potentially malignant disorders as ‘the risk of malignancy being present in a lesion or
Results disorders
condition either during the time of initial diagnosis or at a future date’. Potentially malignant
have variable malignant potentials, and OSMF has a high potential to convert into malignant .
Biological markers for the detection of cancer and pre- cancer can be obtained from several body fluids.
Lactate dehydrogenase is the one tumor marker that can be obtained from serum as well as the saliva.
LDH is a catalytic enzyme present in nearly all the cells, and it catalyzes the conversion of pyruvate to
lactate and vice versa, as well as NADH to NAD+ and vice versa.
Several studies have shown that LDH is released during injuries; hence, it could be a marker for
detection of tissue injury in various diseases. Plasma membrane damage or leakage is associated with
the cell death. Among the enzymes associated with this damage, LDH is the one which is released
whenever there is a damage to the plasma membrane. Hence, quantifying LDH can give an estimation
of the cell death that has occurred. Shpitzer, et al. (2007) , Achalli, et al. (2012), Joshi, et al. (2014),
Metgud, et al. (2015), Pereira, et al. (2015), Sivaramakrishnan, et al. (2015) conducted similar studies
and found statistically significant increase in LDH.
Conclusion: LDH has enormous potential benefits as a screening aid. Clinical diagnosis along with salivary lactate dehydrogenase levels can become
an important diagnostic method in the future. Salivary LDH levels can also serve as a valuable aid in monitoring treatment outcomes in patients with
OSMF. Further studies are required to a larger sample size to establish the exact levels of salivary LDH in patients with OSMF and oral cancer.