Do osmotic pressure and hygroscopicity of areca nut related products drive extracellular fluid loss and condensation of collagen bundles in oral submucous fibrosis?. (June 2022) - Sarode, Sachin C
Highlights: Pathogenesis has never been addressed from the perspective of the physical properties of amalgamated betel quid (BQ) with saliva. Mechanisms related to high osmotic pressure and hygroscopicity of amalgamated BQ are proposed. Extracellular fluid loss is expected due to the high osmotic pressure and hygroscopicity of amalgamated BQ. Dense fibrotic bundles observed in oral submucous fibrosis are a manifestation of such extracellular fluid loss, which brings fibers to close together. Abstract: Increased production and decreased degradation of collagen fibers are the two of hallmarks of oral submucous fibrosis (OSMF). To date pathogenesis of OSMF has been perceived from the perspective of chemical constituents of the betel quid (BQ) and their impact on the signaling pathways related to fibrosis. In the present paper, physical properties such as osmotic pressure and hygroscopicity of the BQ amalgamation formed in the oral cavity are proposed as the causative mechanisms for OSMF. The detailed mechanism of osmotic pressure gradient development between extracellular fluid and the amalgamated BQ in the oral cavity has been deliberated. In addition, the hygroscopicity of BQ is also projected as a complementary mechanism to the osmotic pressure mechanism for OSMF development. Various laboratory experiments, cell culture models, and animal studies are proposed to evaluate the hypothesis. Since OSMF can also occur in only areca nut chewing individuals, we put forth the proposed mechanism as complementary to the already known pathogenesis. This novel hypothesis addresses the age-old problem related to the management of OSMF and extracellular fluid restoration strategies would drastically change and probably improve the clinical status and reduce the malignant potential of OSMF.