|Year : 2016 | Volume
| Issue : 2 | Page : 147-150
Role of antioxidants as a stress factor for potentially malignant, malignant disorders and healthy individuals: A correlative study
Deepankar Misra, Shalu Rai, Sapna Panjwani, Akshay Sharma, Nivedita Singh
Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
|Date of Web Publication||5-Jul-2016|
Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: The possible role of free radicals in pathogenesis of a disease and its prevention by antioxidants is well-known. Literature reveals an independent correlation between the risk factors and these disorders. The aim of the present study was to ascertain the values of vitamin A, vitamin E, superoxide dismutase (SOD), and malondialdehyde (MDA) in normal individuals and patients with potentially malignant and malignant disorders.
Materials and Methods: In this study, serum vitamin A, E, SOD, and MDA levels were assessed in 80 patients divided into four groups marked as a group I normal individuals, group IIa individuals with habits but without any lesions, group IIb with potentially malignant disorders, and group III with malignant disorders.
Results: The mean vitamin A level in the group I was 3.07 ± 0.27, group IIa was 1.48 ± 0.37, group IIb was 0.89 ± 0.21, and group III was 0.67 ± 0.17. The mean vitamin E level in group I was 9.89 ± 0.75, group IIa was 8.85 ± 0.42, group IIb was 7.63 ± 0.39, and group III was 6.43 ± 0.34. The mean MDA level in group I was 2.92 ± 0.36, group IIa was 6.05 ± 0.78, group IIb was 10.13 ± 0.75, and group III was 14.15 ± 0.47. The mean SOD activity level among group I was 189.45 ± 14.17, group IIa was 169.05 ± 4.98, group IIb was 115.65 ± 19.60, and group III was 52.63 ± 4.02.
Conclusion: There was a significant reduction in serum Vitamin A, Vitamin E, and SOD levels whereas there was a significant increase in serum MDA levels in patients with potentially malignant and malignant disorders as compared to normal individuals.
Keywords: Malondialdehyde, superoxide dismutase, vitamin A, vitamin E
|How to cite this article:|
Misra D, Rai S, Panjwani S, Sharma A, Singh N. Role of antioxidants as a stress factor for potentially malignant, malignant disorders and healthy individuals: A correlative study. J NTR Univ Health Sci 2016;5:147-50
|How to cite this URL:|
Misra D, Rai S, Panjwani S, Sharma A, Singh N. Role of antioxidants as a stress factor for potentially malignant, malignant disorders and healthy individuals: A correlative study. J NTR Univ Health Sci [serial online] 2016 [cited 2020 May 25];5:147-50. Available from: http://www.jdrntruhs.org/text.asp?2016/5/2/147/185454
| Introduction|| |
Potentially malignant disorder is the preferred term to describe a number of mucosal lesions which demonstrate an increased risk of malignancy.  Oropharyngeal squamous cell carcinoma (OSCC) is the 10 th leading cancer in the world and an important public health issue in India. The process of carcinogenesis is multi factorial and may also occur by generation of free radicals, which are either derived from essential metabolic processes or from the external sources.  Once formed, they affect cells which may function poorly leading to mutation or cell death. Free radical damage can be prevented by antioxidants that inhibit the process of oxidation. They are broadly classified as nonenzymatic and enzymatic.  Levels of nonenzymatic antioxidants such as vitamins A and E and enzymatic antioxidant like superoxide dismutase (SOD) have been found to be reduced in these disorders whereas enzymatic antioxidants malondialdehyde (MDA) levels are increased. ,
Thus, the present study was undertaken to estimate the levels of antioxidants such as vitamin A, vitamin E, SOD, and MDA in these disorders along with their comparison in healthy controls and to ascertain their diagnostic and prognostic value in these disorders.
| Materials and methods|| |
The study was conducted in patients coming to the outpatient department of the institute. The total number of patients included were 80 in the age group 25-60 years. Patients with clinically suspected oral submucous fibrosis (OSMF), oral leukoplakia (OL), OSCC with a habit of tobacco consumption and not on any antioxidants therapy were included. An informed consent and clearance from Ethical Committee of the institution was obtained and clinically suspected cases were sent for histopathological confirmation. The patients were divided into following groups:
- Group I (control): 20 healthy individual without having any oral lesion or systemic diseases
- Group IIa: 20 individuals with deleterious habits but without any lesions
- Group IIb: 20 patients with clinical and histopathological diagnosis OSMF and OL
- Group III: 20 patients with clinically and histopathological diagnosis with OSCC.
Serum levels were evaluated for vitamin A by using the method given by Karmakar and Rajagopal (1952),  vitamin E was estimated by method given by Nair and Magar (1955).  MDA was estimated by method given by to Kei Satoh (1978),  SOD was estimated by method given by Marklund and Marklund (1974).  The results obtained were statistically analyzed using Statistical Package for the Social Sciences version 16.0 (IBM Company) and Chi-square test was used to determine the level of significance.
| Results|| |
The mean serum vitamin A level among the group I was 3.07 ± 0.27, group IIa was 1.48 ± 0.37, group IIb was 0.89 ± 0.21, and group III was 0.67 ± 0.17 (P = 0.000). The mean vitamin E level among the group I was 9.89 ± 0.75, group IIa was 8.85 ± 0.42, group IIb was 7.63 ± 0.39, and group III was 6.43 ± 0.34 (P = 0.021) [Table 1] and [Figure 1]. The mean MDA level in group I patients was 2.92 ± 0.36, group IIa patients were 6.05 ± 0.78, group IIb patients were 10.13 ± 0.75, and group III patients were 14.15 ± 0.47 (P = 0.000). The mean SOD activity level among group I patients was 189.45 ± 14.17, group IIa patients were 169.05 ± 4.98, group IIb patients were 115.65 ± 19.60, and group III patients were 52.63 ± 4.02 (P = 0.000) [Table 2] and [Figure 2].
| Discussion|| |
Antioxidants and their defense mechanisms prevent our body from free radicals and free radical induced injuries. Disturbances in antioxidant defense mechanism are responsible for the pathogenesis of potentially malignant and malignant disorders such as leukoplakia, erythroplakia, OSMF, and other potentially malignant disorders, which have a well-recognized malignant transformation rate. Studies have shown that fruits and vegetables are rich in antioxidants and have a protective action against these disorders. 
In our study, the mean serum vitamin A level was highest in the control group as compared to other groups with potentially malignant and malignant disorders. Similar findings were found by Lawal et al. in 2012 and explained the possible role of vitamin A in potentially malignant and malignant disorders. It inhibits terminal differentiation of epidermal cells, which arrest and reverse the progression of leukoplakia. It also inhibits cancer by inducing cytotoxic and cytostatic effects on cancer cells and promoting apoptosis of these cells.
The mean serum vitamin E level was also found to be highest in the control group and decreased gradually in patients with potentially malignant and malignant disorders. Our results were similar to the results found by Manoharan et al. in 2005, Premkumar et al. in 2011, and Lawal et al. in 2012. Lawal et al.  in 2012 suggested the possible action of vitamin E in the prevention of potentially malignant and malignant disorder. It acts as a free radical scavenger, and it helps in maintaining membrane integrity. It also inhibits cancer cell growth and differentiation by inhibiting mutagenicity and nitrosamine formation.
The mean MDA level was lowest in healthy individuals and gradually increased in potentially malignant and malignant patients, which was statistically significant. Similar results were found by Rai et al.  in 2010, they also stated injury due to free radical induces lipid peroxidation process. MDA is the stable end product of this process and causes profound alteration in structural integrity and functions of the cell membrane leading to pathogenesis of potentially malignant and malignant disorders. Khanna et al. in 2005 found similar results for MDA and SOD levels in oral potentially malignant and malignant patients and explained the possibility of the relationship between genetic susceptibility, tobacco usage and oxidative stress induced carcinogenesis leading to these disorders. Chole et al. in 2010 found serum MDA levels highest in oral cancer patients and lowest in healthy controls and described MDA as the most common marker of free radical induced lipid peroxidation process responsible for potentially malignant and malignant disorders. They also described MDA as a marker for both preventive clinical interventions.
The mean serum SOD levels gradually decreased when compared to healthy individuals and were highest in healthy individuals followed by patients with potentially malignant disorders and lowest in malignant patients, and the results were statistically significant (P < 0.05). Similar results were found by Gurudath et al.  in 2012 who found lowest erythrocyte SOD levels in 25 patients with malignant disorders and lower in patients with potentially malignant disorders as compared to healthy individuals. They also described SOD as a decisive antioxidant enzyme responsible for elimination of superoxide radicals in aerobic cells. Khanna et al. in 2005 found similar results in 60 patients with potentially malignant and malignant disorders and found low levels of SOD in these patients as compared to healthy controls. However, Gupta et al. in 2004 assessed erythrocyte SOD activity in 34 cases of OSMF and did not find any significant change in any stage of the disease.
| Conclusion|| |
Antioxidant system influences free radical induced oral carcinogenesis in our body. Free radical induced injury is maximal in oral cancer patients thus antioxidants defense mechanisms are compromised in these patients. Levels of antioxidants such as vitamin A, vitamin E, SOD were decreased, and MDA was increased in malignant patients as compared to healthy controls. Thus, it can be concluded levels of vitamin A, vitamin E, MDA, and SOD can be used as prognostic markers for evaluation of free radical induced injury to the tissues leading to potentially malignant and malignant disorders.
| Acknowledgment|| |
The authors would like to thank Dr. Shashank Tyagi, P.hd., Professor and Head, Department of Biochemistry, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
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[Figure 1], [Figure 2]
[Table 1], [Table 2]