Abstract
Oral cancer is a major public health concern in South Asia, particularly in Pakistan, India, and Bangladesh, largely due to the widespread use of smokeless tobacco (SLT) products. The World Health Organization (WHO) classifies SLT as a Group 1 carcinogen. These products contain glycotoxins, such as methylglyoxal (MGO) that is well-known to cause genotoxicity by reacting with DNA. One of the most stable MGO-derived DNA adducts is N2-(1-carboxyethyl)-2′-deoxyguanosine (CEdG), which has been reported to cause DNA damage and genetic instability. However, the role of CEdG in the pathogenesis of oral cancer remains unstudied, and the MGO content in various SLT has not been previously determined. To our knowledge, this study represents one of the first investigations into the abundance of CEdG in oral cancer and its association with chromatin organization, while also quantifying MGO levels in SLT. CEdG was detected using a semi-quantitative in situ immunofluorescence assay and correlated with chromatin computational morphometry to evaluate CEdG-associated alterations in chromatin organization. Using ELISA, we also assessed MGO levels in various SLT, revealing elevated concentrations in commonly used products such as gutka, naswar, and khaini. Our results demonstrated significantly higher levels of CEdG in cancerous nuclei and were strongly correlated with disorganized chromatin texture. Together, these findings suggest that exposure to MGO-rich SLT is associated with CEdG accumulation and subsequent chromatin disorganization, which may be relevant to tobacco-associated oral carcinogenesis.
Data availability
Data are available in supplementary information files.
References
Dhingra, K. Oral cancer: a global threat. J. Indian Med. Assoc. 107, (5), 257–259. https://doi.org/10.1308/rcsbull.2025 (2025).
Jagadeesan, D. et al. Comprehensive insights into oral squamous cell carcinoma: diagnosis, pathogenesis, and therapeutic advances. Pathol. – Res. Pract. 261, 155489. https://doi.org/10.1016/j.prp.2024.155489 (2024).
Pepper, T. S.S. Cancer of the oral mucosa. Treasure Island (FL): StatPearls; (2024). https://pubmed.ncbi.nlm.nih.gov/33351426/.
Service, N. H. Lip and oral cavity (ICD-10 C00, C02–C06) London, UK: NHS England Digital; (2023). https://digital.nhs.uk/ndrs/data/cancer-data-training-materials/staging-sheets/lip-and-oral-cavity.
O’Sullivan, B. et al. The TNM classification of malignant tumours-towards common understanding and reasonable expectations. Lancet Oncol. 18, (7), 849–851. https://doi.org/10.1016/S1470-2045(17)30438-2 (2017).
Wang, X. Z.Z. Oral cancer (IntechOpen, 2021). https://www.intechopen.com/chapters/75405.
Ferlay, J. E. et al. F. Global cancer observatory: Cancer Today Lyon (International Agency for Research on Cancer, 2022). https://gco.iarc.who.int/today.
Anwar, N. et al. Oral cancer: Clinicopathological features and associated risk factors in a high risk population presenting to a major tertiary care center in Pakistan. PLoS One. 15, (8), e0236359. https://doi.org/10.1371/journal.pone.0236359 (2020).
Khan, M. F., Hayhoe, R. P. & Kabir, R. Exploring the risk factors for oral cancer in Pakistan: a systematic literature review. J. Oral Maxillofacial Pathol. 12, (2), 1–19. https://doi.org/10.3390/dj12020025 (2024).
González-Moles, M., Aguilar-Ruiz, M. & Ramos-García, P. Challenges in the early diagnosis of oral cancer, evidence gaps and strategies for improvement: A scoping review of systematic reviews. Cancers 14, (19), 1–24. https://doi.org/10.3390/cancers14194967 (2022).
Jerjes, W. Addressing oral cancer inequalities: a multifaceted approach to equitable healthcare. Br. Dent. J. 237, (11), 837–841. https://doi.org/10.1038/s41415-024-8118-9 (2024).
Dhungana, P. G. S. Oral cancer: A public health challenges- a narrative review. Int. J. Creative Res. Thoughts. 13, (6), 265–268 (2025). https://ijcrt.org/papers/IJCRT2012xxxx.pdf
Gu, K. et al. Molecular mechanism study on the contribution of open-fire flue-curing technology to tobacco leaf aroma. Sci. Rep. 12, (1), 63. https://doi.org/10.1186/s40538-025-00784-0 (2025).
Banožić, M., Jokić, S., Ačkar, Đ., Blažić, M. & Šubarić, D. J. M. Carbohydrates—key players in tobacco aroma formation and quality determination. Molecules 25, (7), 1734. https://doi.org/10.3390/molecules25071734 (2020).
Yiliang, W. C. Flavour chemistry of methylglyoxal and glyoxal. Chem. Soc. Rev. 41, (11), 4140–4149. https://doi.org/10.1039/C2CS35025D (2012).
Phuong-Nguyen, K., McNeill, B. A., Aston-Mourney, K. & Rivera, L. R. Advanced glycation end-products and their effects on gut health. Nutrients 15, (2), 405. https://doi.org/10.3390/nu15020405 (2023).
Schalkwijk, C. & Stehouwer, C. Methylglyoxal, a highly reactive dicarbonyl compound, in diabetes, its vascular complications, and other age-related diseases. Physiol. Rev. 100, (1), 407–461. https://doi.org/10.1016/j.bone.2022.116526 (2020).
Lai, S. W. T., Lopez Gonzalez, E. D. J., Zoukari, T., Ki, P. & Shuck, S. C. Methylglyoxal and its adducts: Induction, repair, and association with disease. Crit. Rev. Biochem. Mol. Biol. 35, (10), 1720–1746. https://doi.org/10.1021/acs.chemrestox.2c00160 (2022).
Tamae, D., Lim, P., Wuenschell, G. E. & Termini, J. Mutagenesis and repair induced by the DNA advanced glycation end product N2-(1-carboxyethyl)-2′-deoxyguanosine in human cells. Biochemistry 50, (12), 2321–2329. https://doi.org/10.1021/bi101933p (2011).
Pischetsrieder, M., Seidel, W., Münch, G. & Schinzel, R. N2-carboxyethyl-2’-deoxyguanosine, a nonenzymatic glycation adduct of DNA, induces single-strand breaks and increases mutation frequencies. Biochem. Biophys. Res. Commun. 264, (2), 544–549. https://doi.org/10.1006/bbrc.1999.1528 (1999).
Ciminera, A. K., Shuck, S. C. & Termini, J. Elevated glucose increases genomic instability by inhibiting nucleotide excision repair. Life Sci. Alliance. 4, (10), e202101159. https://doi.org/10.26508/lsa.202101159 (2021).
Wuenschell, G. E. et al. Mutagenic potential of DNA glycation: Miscoding by (R)- and (S)-N2-carboxyethyl-2’-deoxyguanosine. Biochemistry 49, (9), 1814–1821. https://doi.org/10.1021/bi901924b (2010).
Hope, C. N2-(1-carboxyethyl)-2′-deoxyguanosine (CEdG) a potential biomarker for diabetes: ClinicalTrials.gov; 2019 [updated November 1, 2019]. https://ichgcp.net/clinical-trials-registry/NCT02065310?utm.
Chaudhuri, J. et al. The role of advanced glycation end products in aging and metabolic diseases: bridging association and causality. Cell Metabol. 28, (3), 337–352. https://doi.org/10.1016/j.cmet.2018.08.014 (2018).
Rossi, Y. S. J. inventor; City of Hope, assignee. Methods of quantifying N2-(1-carboxyethyl)-2′-deoxyguanosine (CEDG) and synthesis of oligonucleotides containing CEdG. (2010). United States patent US20100102218A1.
Jaramillo, R. et al. DNA advanced glycation end products (DNA-AGES) are elevated in urine and tissue in an animal model of type 2 diabetes. Chem. Res. Toxicol. 30, (2), 689–698. https://doi.org/10.1021/acs.chemrestox.6b00414 (2017).
Li, H. et al. N2-carboxyethyl-2′-deoxyguanosine, a DNA glycation marker, in kidneys and aortas of diabetic and uremic patients. Kidney Int. 69, (2), 388–392. https://doi.org/10.1038/sj.ki.5000064 (2006).
Lopez Gonzalez, E. J. et al. Methylglyoxal-induced RNA modifications decrease RNA stability and translation and are associated with type 2 diabetes. Mol. Metabolism. 98, 102186. https://doi.org/10.1016/j.molmet.2025.102186 (2025).
Synold, T. W., Termini, J. & Shuck, S. inventor; City of Hope., assignee. Methods of quantifying methylglyoxal–induced nucleic acid adducts. United States patent. 11 https://doi.org/10.1021/tx8002217 (2023).
Synold, T. et al. Advanced glycation end products of DNA: Quantification of N2-(1-carboxyethyl)-2′-deoxyguanosine in biological samples by liquid chromatography electrospray ionization tandem mass spectrometry. Chem. Res. Toxicol. 21, (11), 2148–2155. https://doi.org/10.1021/tx800224y (2008).
Bedin, V., Adam, R. L., de Sá, B. C. S., Landman, G. & Metze, K. Fractal dimension of chromatin is an independent prognostic factor for survival in melanoma. BMC Cancer. 10, (1), 260. https://doi.org/10.1186/1471-2407-10-260 (2010).
Nielsen, B. et al. Association between proportion of nuclei with high chromatin entropy and prognosis in gynecological cancers. J. Natl Cancer Inst. 110, (12), 1400–1408. https://doi.org/10.1093/jnci/djy063 (2018).
Andrade, D., Gifford, H. C. & Das, M. Assessment of influencing factors and robustness of computable image texture features in digital images. Tomography 11, (8), 87. https://doi.org/10.3390/tomography11080087 (2025).
Rahman, T. Y., Mahanta, L. B., Choudhury, H., Das, A. K. & Sarma, J. D. Study of morphological and textural features for classification of oral squamous cell carcinoma by traditional machine learning techniques. Cancer Rep. 3, (6), e1293. https://doi.org/10.1002/cnr2.1293 (2020).
Gao, X. et al. Analytical methods for atmospheric carbonyl compounds: a review. J. Environ. Sci. 16, (1), 107. https://doi.org/10.3390/atmos16010107 (2025).
Radaic, A. et al. Biological biomarkers of oral cancer. Periodontol 2000. 96, (1), 250–270. https://doi.org/10.1111/prd.12542 (2024).
Cohen, J. Statistical power analysis for the behavioral sciences 2nd edn (Routledge, 2013).
Julious, S. A. Sample size of 12 per group rule of thumb for a pilot study. Pharm. Stat. 4, (4), 287–291. https://doi.org/10.1002/pst.185 (2005).
Addenbrooke’s, N. H. S. & Trust, C. Histopathology department manual: Cambridge University Hospitals NHS Foundation Trust.
IHC-WORLD. H&E staining method and protocol – Harris 2024. Available from: https://ihcworld.com/2024/01/25/he-staining-method-and-protocol-harris/.
Nova Scotia Community College (NSCC) / & Hartlen, M. Routine hematoxylin and eosin (H&E): Regressive method — histotechnology lab manual Nova Scotia (Canada): NSCC; 2022 [updated September 5, 2022]. Available from: https://pressbooks.nscc.ca/histotechnology/chapter/88/.
IHC–World. Antigen retrieval method for free floating sections — IHC–world 2024 [updated January 21, 2024]. Available from: https://ihcworld.com/2024/01/21/antigen-retrieval-method-for-free-floating-sections/.
Ino, H. Antigen retrieval by heating en bloc for pre-fixed frozen material. Acta Histochem. Cytochem. 51, (8), 995–1003. https://doi.org/10.1177/002215540305100803 (2003).
Suzuki, T., Matsuzaki, T. & Takata, K. J. Fluorescence counter-staining of cell nuclear DNA for multi-color laser confocal microscopy. 31(4), 297–301. https://doi.org/10.1267/ahc.31.297 (1998).
Frischmann, M., Bidmon, C., Angerer, J. & Pischetsrieder, M. Identification of DNA adducts of methylglyoxal. Chem. Res. Toxicol. 18, (10), 1586–1592. https://doi.org/10.1021/tx0501278 (2005).
Schneider, M. et al. Determination of glycated nucleobases in human urine by a new monoclonal antibody specific for N2-carboxyethyl-2’-deoxyguanosine. Chem. Res. Toxicol. 17, (10), 1385–1390. https://doi.org/10.1021/tx049929d (2004).
Roy, N. K. et al. Isoform-specific role of Akt in oral squamous cell carcinoma. Biomolecules 9, (7), 253. https://doi.org/10.3390/biom9070253 (2019).
Das, A., Bhattacharya, A., Chakrabarty, S., Ganguli, A. & Chakrabarti, G. Smokeless tobacco extract (STE)-induced toxicity in mammalian cells is mediated by the disruption of cellular microtubule network: a key mechanism of cytotoxicity. PLoS One. 8, (7), e68224. https://doi.org/10.1371/journal.pone.0068224 (2013).
Acknowledgements
We sincerely thank Prof. Monika Pischetsrieder (Department of Chemistry and Pharmacy, Food Chemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany) for the kind gift of the N2-(1-carboxyethyl)-2′-deoxyguanosine (CEdG) monoclonal antibody. The CEdG antibody was specially provided for the PhD research project of Gulnaz Khan.
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GK & RSW designed the study. GK performed the experiments, analyzed the data, and wrote the manuscript. RSW, RZA, HK reviewed and edited the manuscript. All authors read and approved the final version of the manuscript.
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The study was approved by the Institutional Review Board (IRB), Jinnah Postgraduate Medical Center (JPMC), Jinnah Hospital, Karachi (Ref No. NO.F.2–81/2020-GENL/48723/JPMC), and was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to inclusion in the study.
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Khan, G., Waraich, R.S., Khan, H. et al. N2-(1-carboxyethyl)-2′-deoxyguanosine as a genotoxic glycation marker associated with chromatin architectural alterations in oral squamous cell carcinoma. Sci Rep (2026). https://doi.org/10.1038/s41598-026-45839-w
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DOI: https://doi.org/10.1038/s41598-026-45839-w