RESUMO
RESUMEN: Determinar el rol de la vitamina D (VD) en el desarrollo y tratamiento de liquen plano oral (LPO). Se realizó una revisión sistemática exploratoria durante el mes de Abril del 2021 utilizando Pubmed/Medline, Ebsco y Scopus/ Elsevier. Se utilizaron los términos "Oral lichen planus" y "Vitamin D". Se incluyeron sólo estudios en humanos y fueron excluidos aquellos de más de 5 años de antigüedad. Se obtuvieron 40 artículos, de los cuales 15 se descartaron por estar duplicados. Al seleccionar según título y resúmenes, 7 publicaciones cumplían con los criterios para ser incluidas en esta revisión. Diversas investigaciones han cuantificado niveles de VD en pacientes con LPO obteniendo mediciones significativamente más bajas que en pacientes sanos. Además, se describe una posible correlación entre la severidad del cuadro y la magnitud del déficit. Finalmente, la suplementación con VD como coadyuvante surge como alternativa para la disminución de síntomas dado su rol en procesos inmunes y a reportes de mejoras en cuadros de LPO a partir de su uso. Pacientes diagnosticados con LPO tienen niveles insuficientes de VD sérica en comparación con pacientes sanos. La deficiencia del micronutriente se relaciona con una respuesta inflamatoria exagerada y alteraciones del sistema inmune. La suplementación de VD en pacientes con LPO sería beneficiosa como coadyuvante al tratamiento con corticosteroides en casos severos. Sin embargo, la escasa evidencia hace necesario realizar más estudios clínicos que reafirmen la efectividad de la VD como tratamiento complementario de LPO.
ABSTRACT: To determine the role of vitamin D (VD) in the development and treatment of oral lichen planus (OLP). An exploratory systematic review was carried out during April of 2021 using the databases Pubmed / Medline, Ebsco and Scopus / Elsevier. The terms "Oral lichen planus" and "Vitamin D" were used. Only human studies were included and those publications older than 5 years old were excluded. 40 articles were obtained, of which 15 were discarded because they were duplicated. When selecting according to title and abstract, publications met the criteria to be included in this review. Various investigations have quantified VD levels in patients with OLP: obtaining significantly lower measurements than in healthy patients. In addition, a possible correlation between the severity of the condition and the magnitude of the deficit is described. Finally, supplementation with VD as an adjuvant arises as an alternative for the reduction of symptoms, given the role of VD in immune processes and reports of improvements in OLP symptoms with its use. Patients diagnosed with OLP have insufficient levels of serum VD compared to healthy patients. Micronutrient deficiency is related to an exaggerated inflammatory response and alterations in the immune system. VD supplementation in patients with OLP would be beneficial as an adjunct to corticosteroid treatment in severe cases. However, the limited evidence makes it necessary to carry out more clinical studies to reaffirm the effectiveness of VD as a complementary treatment for OLP.
RESUMO
Polycyclic aromatic hydrocarbons (PAHs) contained in tobacco smoke acquire carcinogenicity following their activation by xenobiotic-metabolizing enzymes to highly reactive metabolites. The cytochrome P4501A1 (CYP1A1) enzyme is central to the metabolic activation of these PAHs, and GSTM1 is the main enzyme responsible for its detoxification. CYP1A1 and GSTM1 polymorphisms were evaluated in 124 Chilean healthy controls and 48 oral cancer patients through PCR-based restriction fragment length polymorphism. In the healthy controls, frequencies of the CYP1A1 variant alleles for m1 (CYP1A1(*)2A) and the GSTM1null genotype were found to be 0.25 and 0.19, respectively. In the oral cancer patients, these frequencies were 0.33 and 0.50, respectively. Thus, the GSTM1 and m1 rare alleles were significantly more frequent in the oral cancer patients compared to the controls. The estimated relative risk for oral cancer associated with the single genotype CYP1A1 or GSTM1 was 2.08 for wt/m1, 1.04 for m1/m1 and 4.16 for the GSTM1null genotype. For smokers, the estimated relative risk (adjusted by age and gender) was higher in the individuals carrying the m1 allele of CYP1A1 [wt/m1: odds ratio (OR)=5.68, P=0.0080; m1/m1: OR=7.77, P=0.0420] or GSTM1null genotype (OR=20.81, P<0.0001). Combined genotypes CYP1A1 and GSTM1 increased the risk significantly (wt/m1/GSTM1null: OR=19.14, P=0.0030; m1/m1/GSTM1null: OR=21.39, P=0.0130). Taken together, these findings suggest that Chilean individuals carrying single or combined GSTM1 and CYP1A1 polymorphisms may be more susceptible to oral cancer induced by environmental tobacco smoking.