muramidase and Head-and-Neck-Neoplasms

Dental care costs in the United States exceed $100 billion annually. Personalized medicine efforts in dentistry are driven by potentially compelling clinical utility and cost-effectiveness prospects in the major diseases of periodontitis, caries, and oral cancers. This review discusses progress and challenges identifying genetic markers and showing clinical utility in dentistry. Genome-wide association studies (GWAS) of chronic periodontitis (CP) identified no significant variants, but CDKN2BAS variants on chromosome 9 were significantly associated with aggressive periodontitis. Stratifying patients by interleukin (IL)-1 gene variants, smoking and diabetes differentiated CP prevention outcomes. Dental caries' GWAS identified significant signals in LYZL2, AJAp1, and KPNA4; and efforts are ongoing to identify genetic factors for multiple caries phenotypes. Trials of molecularly targeted therapies are in progress for oral, head, and neck squamous cell carcinomas (OHNSCC) and results have been promising but limited in their effectiveness. Current opportunities and challenges for molecular targeting for OHNSCC are discussed.

Topics: alpha Karyopherins; Carcinoma, Squamous Cell; Cell Adhesion Molecules; Dental Caries; Genetic Markers; Genetic Variation; Genome-Wide Association Study; Head and Neck Neoplasms; Humans; Interleukin-1; Mouth Neoplasms; Muramidase; Periodontitis; Precision Medicine; RNA, Long Noncoding

One of the major side effects of radical radiation therapy for head and neck malignancies is xerostomia, or dryness of the mouth. There is no clearly effective treatment for this condition, but we have observed that patients in our practice believe that their symptoms improve significantly when using two "over-the-counter" oral comfort products - Biotene (toothpaste, mouthwash and chewing gum) and Oralbalance gel. We decided to study these agents in a formal phase II study to evaluate their usefulness in patients with postirradiation xerostomia. Twenty-eight patients with post-irradiation xerostomia were entered on the study. All had biopsy-proven carcinoma of the nasopharynx, oropharynx, oral cavity, hypopharynx or larynx, and had received primary radiotherapy with curative intent (> or =50 Gy in 20 fractions) more than 4 months before study entry. More than 75% of both parotid glands were included in the primary radiation field. There was no clinical evidence of recurrent disease. Patients were provided with a 2-month supply of Biotene mouthwash, toothpaste, chewing gum and Oralbalance gel. Response was evaluated 1 and 2 months after study entry using a patient-completed visual analogue scale to assess the severity of xerostomia and its effects on quality of life. For analysis, the scored baseline was subtracted from the later scores to assess change. Patients with an increase of 10 mm from their baseline score on the visual analogue scale were classified as having responded to the treatment intervention, and those with an increase of > or =25 mm from their baseline score were classified as having experienced a major improvement in their symptoms. After 2 months of treatment, 15 patients (54%) reported an improvement in intraoral dryness and 10 of these patients (36%) reported a major improvement. Similar proportions of patients (46% some improvement, 25% major improvement) reported an improvement in their ability to eat normally. Seventeen patients (61%) reported an improvement in oral discomfort, and 12 of these (43%) had a major improvement in their symptoms. The results of this study suggest that the use of Biotene (mouthwash, toothpaste and chewing gum) and Oralbalance gel can improve many of the symptoms of radiation-induced xerostomia. A placebo effect could account for many of the observed improvements in symptoms, and in order to assess the role of these agents in the management of patients with postirradiation xerostomia a randomised phase III

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Drug Combinations; Female; Glucose Oxidase; Head and Neck Neoplasms; Humans; Lactoperoxidase; Male; Middle Aged; Muramidase; Radiotherapy; Surveys and Questionnaires; Treatment Outcome; Xerostomia

Myeloid sarcoma of the head and neck region can pose diagnostic challenges because of the low frequency of myeloid sarcoma and the potential for tumors of almost any lineage to occur in the head and neck.. To study the clinicopathologic and immunohistochemical characteristics of myeloid sarcoma in the head and neck region and to review the differential diagnosis.. We searched for cases of myeloid sarcoma involving the head and neck region for a 24-year period at our institution. The medical records and pathology slides were reviewed. Additional immunohistochemical stains were performed.. We identified 17 patients, age 17 to 85 years. Most tumors involved the oral cavity. Myeloid sarcoma was the initial diagnosis in 9 patients (53%); the remaining 8 patients (47%) had a history of bone marrow disease. Immunohistochemical analysis using antibodies specific for lysozyme, CD43, and CD68 were highly sensitive for diagnosis but were not specific. By contrast, assessment for myeloperoxidase in this study was less sensitive but more specific. We also used antibodies specific for CD11c and CD33 in a subset of cases, and these reagents seem helpful as well.. The clinical presentation of myeloid sarcoma involving the head and neck, particularly the mouth, is often nonspecific, and a high degree of suspicion for the possibility of myeloid sarcoma is needed. Immunohistochemistry is very helpful for establishing the diagnosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Bone Marrow Diseases; CD11c Antigen; Diagnosis, Differential; Female; Head and Neck Neoplasms; Humans; Immunohistochemistry; Leukosialin; Male; Middle Aged; Muramidase; Peroxidase; Sarcoma, Myeloid; Sialic Acid Binding Ig-like Lectin 3; Young Adult

Xerostomia is a common complication of radiotherapy for head and neck cancer. Symptomatic treatment consists of stringent oral hygiene to prevent oral infections and saliva substitutes to increase comfort. The aim of the study was to evaluate the clinical effectiveness of the BioXtra (BX) dry mouth care system.. A xerostomia questionnaire consisting of 3 parts (xerostomia symptom score, quality of life (QoL) survey and visual analogue scale (VAS)) was completed by 34 patients suffering from radiation-induced xerostomia, before and after 4 weeks of treatment with the BioXtra moisturizing gel, toothpaste and mouthwash.. The BioXtra products significantly diminished the most common symptoms of xerostomia. Mean VAS score at the start of treatment was 59.8. After treatment, this decreased to 36.4 (p < 0.001). Twenty-six patients (77%) responded to treatment, 11 of these patients (32%) reported a major improvement. Quality of life significantly improved under treatment: mean QoL score at the start was 59.4; this increased to 70.5 (p < 0.001). None of the 34 patients reported any adverse effects and all but 1 patient found the BX dry mouth care system easy to use.. The results of this study suggest that the BioXtra dry mouth care system is effective in reducing the symptoms of radiation-induced xerostomia and improving the quality of life of xerostomia patients, even if a proportion of the benefit is due to a placebo effect. However, further research is necessary to evaluate the efficacy of BioXtra on oral health.

Topics: Aged; Aged, 80 and over; Complex Mixtures; Female; Head and Neck Neoplasms; Health Surveys; Humans; Lactoferrin; Lactoperoxidase; Male; Middle Aged; Muramidase; Pain Measurement; Proteins; Psychological Tests; Psychometrics; Quality of Life; Radiation Injuries; Radiation Oncology; Radiotherapy; Radiotherapy Dosage; Risk Factors; Saliva; Salivation; Surveys and Questionnaires; Xerostomia; Xylitol

Immunohistochemical analysis of 21 prototypic mucosal spindle-cell carcinomas of the aerodigestive tract was performed at the Armed Forces Institute of Pathology (AFIP) to establish the usefulness of selected immunohistochemical markers in distinguishing spindle-cell carcinoma from other mucosal spindle-cell neoplasms. Immunoreactive keratin could be demonstrated in only 13/21 (62%) of cases. Coexpression of keratin and vimentin was demonstrated in 10/17 (59%) of the tumors evaluated for both of these intermediate filaments. All spindle-cell carcinomas lacked S100 protein, which is an immunoreactivity we would expect to find in spindle-cell malignant melanoma, one of the principal considerations in a differential diagnosis. Both alpha-1-antitrypsin (AAT) and alpha-1-antichymotrypsin (ACT) were demonstrated in the tumor cells in all cases. However, albumin had a similar distribution in the tumors, which suggested that passive uptake was a serious confusing factor. The results of this study indicate that AAT and ACT are unreliable markers for distinguishing spindle-cell carcinomas from malignant fibrous histiocytomas.

Topics: Aged; alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; Antigens, Neoplasm; Carcinoma; Female; Head and Neck Neoplasms; Humans; Keratins; Male; Middle Aged; Muramidase; S100 Proteins; Serum Albumin; Vimentin

Sixteen patients with head and neck cancer were administered lysozyme chloride for more than 6 months in combination with chemotherapy, irradiation and/or surgery. The patients had no side effects due to lysozyme chloride. The immune responses of the patients were examined by phytohemagglutinin (PHA) and purified protein derivative (PPD) intradermal injection tests. After the administration of lysozyme chloride for 6 months, the PHA and PPD responses of the patients, whose initial reaction values were average of less, were found to have significantly increased (paired sample t-test, p less than 0.05).

Topics: Adjuvants, Immunologic; Adult; Aged; Evaluation Studies as Topic; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Muramidase; Skin Tests

Immunologic studies demonstrate that non-Hodgkin's lymphomas are derived predominantly from B- or T-lymphoid cells, while node-based tumors of true histiocytic derivation are rare, with few documented cases. This report describes the clinical, histologic, immunohistochemical, and ultrastructural features of two cases of node-based true histiocytic lymphoma. Distinctive ultrastructural features included numerous cytoplasmic lysosomes, surface microvillous processes, and occasional cell junctions, and the cells stained strongly for alpha-napthyl acetate esterase and alpha one-antitrypsin. Since there are few specific histologic features, special technics may be essential in confirming the diagnosis of true histiocytic lymphoma, and determining appropriate therapy.

Topics: alpha 1-Antitrypsin; Antigens, Surface; Head and Neck Neoplasms; Histiocytes; Histocytochemistry; Humans; Lymphoma; Male; Microscopy, Electron; Middle Aged; Muramidase