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Oral squamous cell carcinoma is a common malignancy affecting Asians.1 Among the various known risk factors for OSCC, areca nut chewing is a common occurrence in countries, such as India.2 The increasing incidence of consumption of areca nut has nullified the awareness programs that have only targeted tobacco as a major risk factor. The primary constituent of areca nut—alkaloid arecoline—has been identified as a group I carcinogen. Arecoline has genotoxic, cytotoxic, and mutagenic effect on various cells.3 Studies have implicated areca nut chewing as a cause for submucous fibrosis, oral cancer, hepatocellular carcinoma, carcinoma of cervix, lung, and stomach.4 Areca nut is either consumed in isolation or taken in the form of betel quid along with tobacco, catechu, lime, and sweeteners. This augments the carcinogenicity due to the effect of lime and betel leaf component—safrole.5 Hypoxia-inducible factor-1 alfa is a key transcription factor induced by hypoxia and activates a transcription program that promotes the survival of cells in a hypoxic state. Studies have indicated a plausible role of arecoline in HIF expression through reactive oxygen species (ROS) pathway.6 The present study was planned to evaluate the effect of areca nut consumption on HIF-1α levels. Our hypothesis is that arecoline leads to stabilization of HIF-1α even under normoxic conditions, thereby leading to more aggressive tumors in areca nut chewers. 1Resident, 2Associate Professor, 3Director and Professor 4Professor and Head, 5Registrar, 6-8Senior Resident 1,5Department of Biochemistry, Lady Hardinge Medical College & Associated SSK & KSC Hospitals, New Delhi, India

Effect of Areca Nut Consumption on Hypoxia-inducible Factor-1 Alfa Expression in Patients with Oral Squamous Cell Carcinoma