Epithelial–mesenchymal transition as a driver of malignant transformation in oral sub-mucnous fibrosis

Introduction: OSF has high malignant transformation rates; the role of EMT in OSF → OSCC progression was investigated. Methods: IHC for epithelial (E-cadherin, pan-cytokeratin) and mesenchymal/stemness markers (N-cadherin, vimentin, α-SMA, CD44) on 30 OSF, 30 OSF-associated OSCC, 30 primary OSCC. Bioinformatic analyses of public transcriptomes (GEO, TCGA HNSC) to identify EMT-related genes. Results: Progressive loss of epithelial markers and gain of mesenchymal/stemness markers observed; CD44 highest in OSF-associated OSCC. Bioinformatics identified ITGA5, SPARC, and MMP9 as enriched EMT-related genes in OSF-associated OSCC. Conclusions: OSF progression involves a shift to an invasion-driven EMT program; ITGA5, SPARC, MMP9 are candidate biomarkers/targets for preventing malignant transformation.