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How does arecanut habit lead to Oral diseases?

Chewing arecanut or betel nut is a very common practice in our country, and arecanut has very important place in cultural and religious life of different communities. Although people believe that it has various health benefits, it is an established fact that habitual arecanut use can cause cancer. A major health hazard caused by arecanut is Oral submucous fibrosis (OSF), which is a pre-cancerous condition commonly found in South and South East Asians.

OSF is characterized by inflammation and damage of the mouth, and excessive deposition of matrix on the oral cavity. The research group under the guidance of Prof. Paturu Kondaiah at the Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore have studied the changes in arecanut induced gene expression profile in comparison to normal cells and revealed that arecanut triggers certain molecular pathways that lead to OSF.

“OSF is prevalent in South East Asian countries, India being one of them. All of these have high consumption of arecanut. With more than 5 million patients in India itself, it is imperative that more research be done for better management of the disease in clinics and if possible, a cure”, said Prof Kondiah.

In this study, the research group studied 'fibroblast' cells, which produce collagen and other tissues in the human body. These cells are considered to be the main reason for the OSF to manifestation. The researchers exposed the cells to arecanut and TGF-β, a protein that regulates cell growth.

The results showed that arecanut causes the progression of OSF, by regulating gene expression in the cells. The outcome – OSF – seemed to be a combined effect of arecanut and TGF-β regulation. The study also found that arecanut had a different effect on fibroblasts and on 'epithelial' cells – those forming the outer lining of our body, like the skin and lining of the mouth. This showed that OSF will progress differently, depending on the type of cell.

“The results of our study highlight that arecanut has profound and direct impact on the epithelial cells of the oral cavity. The growth factors released by these cells in response to arecanut then drive the underlying fibroblast cells to become hyper-activated and secrete fibrous material like collagen outside the cell. This interaction between epithelial cells and fibroblast cells in response to arecanut is what essentially drives this disease forward” said Ila Pant, a PhD student in Kondiah's lab.

“Oral Submucous Fibrosis, in advanced stages is a highly morbid condition. From our studies for over a decade, we have provided several clues for its progression and the role of arecanut and the molecular pathways associated with this disease. The major questions are -- why is this disease irreversible? And, can we find out ways to reverse this disease that may benefit patients?” said Prof. Kondaiah. Their research outcome might have immense contribution for further research works to find preventive measures against OSF.

OSF is a preventable disorder if arecanut consumption is avoided. There has not been any report of an OSF patient who is not an arecanut chewer, as informed by Ila. Thus regular users of arecanut are in potential danger.

“Prevention is better than cure. It has been observed that all the OSF patients have been regular users/chewers of areca nut in the form of gutkha, pan masala etc. for long periods of time. The constant chewing causes abrasion of the mucous membranes in the oral cavity. Moreover, arecanut components keep depositing in the sub-mucosa layer beneath the outer layer, eventually manifesting the disease symptoms. I would therefore suggest its use to a minimum and if possible abstain from it”, said Ila Pant.

About the authors

Paturu Kondaiah is a Professor at Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Bangalore Karnataka, India. Ila Pant is a PhD research scholar at Prof. Kondaiah’s Lab; Neeraj Kumar and Imran Khan are former Research Scholars in Prof. Kondaiah’s lab. Somanahalli Girish Rao is an Oral and Maxillofacial surgeon at D.A. Pandu Memorial—R.V. Dental College and Hospital, Bangalore.; 080-22932688

About the study

The paper appeared online in the journal PLOS ONE.