Background
Smokeless tobacco use is one of the most common causes of oral cancer globally. Naswar, a type of locally manufactured smokeless tobacco product in Pakistan is also associated with high risk of oral cancer but the underlying mechanism of carcinogenicity is not known. Programmed Death-Ligand 1 (PDL-1) is a crucial protein in immune response regulation, particularly in cancer, and its role in Naswar users' oral mucosa remains poorly understood.
Objective
To investigate PDL-1 expression in the oral mucosa of Naswar users, elucidating its potential implications for oral health and cancer development.
Methodology
This lab-based comparative observational study involves male Naswar users and non-users (n = 50 each group) from Peshawar, Pakistan. Following a written informed consent, data on demographics, Naswar usage and oral health and hygiene practices were collected using standardized questionnaires. Clinical examinations, cytological smears, and saliva samples were obtained for analysis. Immunohistochemistry techniques were employed to assess PDL-1 expression in oral mucosa cells, and for statistical analyses SPSS-v27 was used to analyze the association between the Naswar usage and PDL-1 expression profile.
Results
Naswar users exhibited lower adherence to oral hygiene practices compared to non-users. Immunohistochemical analysis revealed varying levels of PDL-1 expression among Naswar users, with 86 % showing no expression, 10 % demonstrating weak expression, and 4 % exhibiting moderate expression, with a significant difference of p = 0.023, in contrast to non-users. Additionally, no significant association was found between oral hygiene status and PDL-1 expression among naswar users.
Conclusion
Naswar users exhibited higher levels of PD-L1, potentially suggesting a heightened immunomodulatory response or adaptive mechanism the immune system employs to dampen immune responses and maintain tissue homeostasis in the face of chronic irritation and potential cellular damage caused by toxic Naswar constituents.
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