Evaluation of the role of salivary survivin and caspase-3 in apoptosis regulation in oral submucous fibrosis and oral squamous cell carcinoma among gutka chewers.

BACKGROUND: This study evaluates salivary Survivin and Caspase-3 as key regulators of apoptosis across a disease spectrum-from gutka chewers without lesions to oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC). Survivin, an anti-apoptotic protein, and caspase-3, the principal executioner caspase, represent crucial biomarkers of malignant transformation, especially in populations with high smokeless tobacco exposure. MATERIALS AND METHODS: A cross-sectional analytical study included 92 participants divided into: controls (n = 17), gutka chewers without lesions (n = 25), OSMF (n = 25), and OSCC (n = 25). Unstimulated saliva samples were collected and analysed for Survivin and Caspase-3 using ELISA. Statistical analysis included Pearson correlation and Kruskal-Wallis. RESULTS: Mean survivin levels demonstrated a progressive increase from healthy subjects (1.00 ± 0.73 pg/ml) to gutka chewers without lesions (2.00 ± 1.36 pg/ml), OSMF (3.50 ± 2.82 pg/ml), and OSCC (5.00 ± 3.04 pg/ml), indicating a trend towards increased anti-apoptotic activity with disease progression. In contrast, Caspase-3 levels showed a biphasic pattern, measuring 4.90 ± 4.43 ng/ml in healthy subjects, 4.50 ± 2.71 ng/ml in gutka chewers without lesions, decreasing to 3.50 ± 2.82 ng/ml in OSMF, and subsequently increasing to 5.50 ± 3.62 ng/ml in OSCC. CONCLUSION: Survivin demonstrated potential as a biomarker of malignant transformation in gutka-associated oral potentially malignant disorders, while the non-linear pattern of Caspase-3 highlights the complex regulatory interactions involving apoptosis suppression, hypoxic adaptation, and possible apoptosis-induced proliferation. However, both biomarkers may serve as potential indicators of disease progression, pending validation through larger multi-centre studies with longitudinal follow-up.