Baig Saeeda, Rubab Zile, Farooq Wasfa
Department of Biochemistry, Ziauddin University, Clifton, Karachi.
J Coll Physicians Surg Pak. 2018 May;28(5):381-385. doi: 10.29271/jcpsp.2018.05.381.
In Pakistan, extensive use of several precarious chewable tobacco formulations has made oral cancer the second leading malignancy. Selection of literature was done by a survey of studies published from 1990 to 2017 mainly, from PUBMED and few from other search engines, on naswar, gutka, areca nut and betel quid, which included published reviews, original articles and other data sources on chewable tobacco, its epidemiology, pathological implications, and psychological effects. These studies have revealed that the chemicals in these formulations bind and mutate DNA of oral mucosa through down regulating cellular repair pathways and upregulating genetic networks associated with pathogenesis. Areca nut, having aercoline (the major alkaloid) causes carcinogenicity, mutagenicity, and genotoxicity of oral mucosa through increased production of growth factors and corticotrophin-releasing hormone, and genetic alteration in expression of CASP8, APAF-1, BAX, BAD, and upregulation of caspas-3. Gutka addiction leads to precancerous lesions resulting in characteristic facial abnormalities, following trismus. Naswar, in addition to oral cancer, causes adverse cardiovascular events by reducing glutathione per oxidase (GPx) and super-oxide dismutase (SOD), serum levels of HDL, whereas, increasing the ratio of cholesterol, LDL, triglycerides and LDL-C/HDL-C. Betel quid (Paan), causes psychoactivity affecting central and autonomic nervous systems leading to dependence with decreased cognition, euphoria, sweating, salivation, palpitation, heightened alertness and zest to work. Metabolically, cardio-acceleration, cortical desynchronisation of EEG, elevated plasma noradrenaline and adrenaline were found. This review highlights the corrosive effects of various most popular chewable tobacco formulations; and damage done by their cocktail of carcinogenic substances and added ingredients, leading to oropharangeal cancer.
在巴基斯坦，几种危险的咀嚼烟草制剂的广泛使用已使口腔癌成为第二大常见恶性肿瘤。文献的选取主要通过对1990年至2017年发表的研究进行调查，这些研究主要来自PubMed，少数来自其他搜索引擎，涉及鼻烟、古特卡、槟榔和槟榔块，包括已发表的综述、原创文章以及其他关于咀嚼烟草的数据源、其流行病学、病理影响和心理效应。这些研究表明，这些制剂中的化学物质通过下调细胞修复途径和上调与发病机制相关的基因网络，与口腔黏膜的DNA结合并使其发生突变。槟榔含有槟榔碱（主要生物碱），通过增加生长因子和促肾上腺皮质激素释放激素的产生以及CASP8、APAF-1、BAX、BAD表达的基因改变和caspas-3的上调，导致口腔黏膜的致癌性、致突变性和基因毒性。古特卡成瘾会导致癌前病变，继而出现特征性面部异常，随后出现牙关紧闭。除了口腔癌，鼻烟还会通过降低谷胱甘肽过氧化物酶（GPx）和超氧化物歧化酶（SOD）、血清高密度脂蛋白（HDL）水平，导致不良心血管事件，同时增加胆固醇、低密度脂蛋白（LDL）、甘油三酯和LDL-C/HDL-C的比例。槟榔会产生精神活性，影响中枢和自主神经系统，导致依赖，同时伴有认知能力下降、欣快感、出汗、流涎、心悸、警觉性提高和工作热情高涨。在代谢方面，发现有心率加快、脑电图皮质去同步化、血浆去甲肾上腺素和肾上腺素升高。本综述强调了各种最流行的咀嚼烟草制剂的腐蚀性影响，以及它们的致癌物质和添加成分混合物所造成的损害，这些会导致口咽癌。
