Altered immunoexpression of SOX2, OCT4 and Nanog in the normal-appearing oral mucosa of tobacco users.

BACKGROUND: Tobacco use is causatively associated with various human cancers, including oral carcinoma. A number of pathways have been delineated to describe its etiopathological link with oral carcinogenesis, including alterations in the expression of stem cell markers. Embryonic stem cell markers, such as sex-determining region Y-box 2 (SOX2), octamer-binding protein 4 (OCT4) and homeobox protein Nanog, which are mainly involved in the maintenance of stemness and pluripotency, have been positively associated with the pathogenesis of oral potentially malignant disorders and oral cancers. In this context, we attempted to explore the subcellular impact of tobacco through examining the expression of these stem cell markers in normal and normal-appearing oral mucosa in non-tobacco users and tobacco users. OBJECTIVES: The aim of the study was to analyze the immunoexpression of SOX2, OCT4 and Nanog in the normal-appearing oral mucosa (NAOM) of tobacco users as compared to the normal oral mucosa (NOM) of non-tobacco users. MATERIAL AND METHODS: The tissue samples of tobacco users and non-tobacco users (n = 50 per group) were immunohistochemically stained to assess the expression of SOX2, OCT4 and Nanog. RESULTS: In the oral mucosa of non-tobacco users, a peculiar parabasal expression pattern of SOX2 and OCT4 was observed, whereas Nanog was non-reactive. The grade of inflammation was found to be a predictive variable influencing the expression of the 2 markers. In tobacco users, variables such as male gender, mixed habit and basilar hyperplasia significantly controlled the basilar and suprabasilar expression of SOX2, OCT4 and Nanog. The expression of SOX2 and OCT4 was higher in tobacco users; in particular, OCT4 positivity was significantly increased (p < 0.001) in comparison with non-tobacco users. CONCLUSIONS: The altered expression of the examined stem cell markers could be an indication of early molecular changes in NAOM under the influence of tobacco.