Cold Atmospheric Plasma for the treatment of Oral Lichen Planus as intraoral precancerous lesion

Abstract

Background

Carcinogenesis of head and neck tumor is a multiphase process that leads from the initial transformation of normal cells to a clinically manifest cancer with a latency of month to decades. Oral lichen planus (OLP) is one of the common immune-mediated mucocutaneous disease characterized by chronic inflammatory process, in which an immune response attacks the lining epithelium. Several prospective and retrospective studies reported malignant transformation rates of OLP ranging from 0 to 10%. In this clinical study, we examined the therapeutic potential of Cold Atmospheric Plasma (CAP) for the treatment of OLP as intraoral precancerous lesions.

Material & Methods

For preclinical in-vitro investigations, tissue samples have been collected from healthy and diseased mucosal regions from 10 patients suffering from OLP. For detection of CAP-related cell death, investigation of DNA fragmentation using the TUNEL-assay has been performed after CAP treatment. Supernatant culture medium of tissue samples were analyzed for 13 different cytokines. Furthermore, white cell populations were stained in CAP-treated tissue samples. Saliva was collected for quantification of inflammatory markers. In addition, five patients suffering from intraoral leukoplakia of the cheek have undergone an in-vivo treatment using the plasma jet kINPen MED. Intraoral treatments have been performed for a period of 1 min/cm2 and with a continuous exhausting of gas and salivary.

Results

No significant enlargement of apoptotic cells could be detected after plasma exposure within the tissue. At the time this abstract was completed no final data concerning changes in cytokines as well as white cell population were available. The in-vivo treatment of OLP tissue revealed a reduction of pain and local inflammation. Especially the treatment of a therapy-resistant erosive OLP of the cheek could achieve pain reduction and a cure of mucosal ulcers.

Conclusion

Previous studies were primarily concerned with plasma effects on cancer cells and its value in cancer treatment. This is the second report about plasma treatment of intraoral precancerous lesions. It has been shown that CAP could be useful in the treatment of intraoral mucosa diseases, especially OLP as precancerous lesion. The treatment of precancerous lesions could prevent the development of cancer and obviate the need for cancer treatment. A larger number of cases, investigation of long-term effects, and clinical studies are needed to further qualify plasma for treatment of precancerous lesions.

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Figure shows the right cheek of a multimorbid patient suffering from a therapy-resistant erosive OLP before (left), during (middle), and after (right) CAP treatment. All volunteers gave written and informed consent to participate in the laboratory and clinical study.