Cytological Alterations and E-Cadherin Expression in the Oral Mucosa of Shisha Smokers in Saudi Arabia

Faris M Elmahdi, Maha Aouad

Abstract: Background: Shisha smoking is a prevalent form of tobacco use in Saudi Arabia and is a significant risk factor for oral cancer. Tobacco exposure alters cellular processes such as adhesion, proliferation, and differentiation. E-cadherin, a key cell adhesion molecule, plays a critical role in maintaining epithelial integrity, and its dysregulation may contribute to oral mucosal pathology. Objective: This study aims to assess cytological changes and the immunohistochemical expression of E-cadherin in the oral mucosa of Saudi shisha smokers. Methods: A cross-sectional study was conducted from March to June 2025, involving 200 buccal mucosa samples from Saudi participants of both genders. The study included 100 shisha smokers and 100 non-smokers as controls. Samples were collected using exfoliative cytology techniques. Immunohistochemical staining was performed to evaluate E-cadherin expression by assessing staining intensity and the percentage of positively stained cells. Data analysis was conducted using SPSS, with categorical variables expressed as frequencies and percentages. The chi-square test was used to assess associations, considering P<0.05 as statistically significant. Results: Cytological abnormalities such as cellular atypia, inflammation, and binucleation were significantly more frequent in shisha smokers (46%) compared to non-smokers (18%) (P-0.012). A marked increase in positive E-cadherin expression was observed in the oral mucosa of shisha smokers (23%) compared to non-smokers (3%) (P-0.005). No significant differences in E-cadherin expression were found across age groups (P-0.48) or gender (P-0.21). Conclusion: The findings highlight that shisha smoking induces significant cytological alterations and downregulation of E-cadherin in the oral mucosa, suggesting early disruption of epithelial integrity and increased risk for malignant transformation. These results emphasize the need for public health measures targeting shisha use and the potential of E-cadherin as a biomarker for early oral mucosal changes in smokers.

Keywords: Cytological changes, Oral mucosa, E-cadherin, Shisha smokers, Saudi Arabia

How to Cite?: Faris M Elmahdi, Maha Aouad, "Cytological Alterations and E-Cadherin Expression in the Oral Mucosa of Shisha Smokers in Saudi Arabia", Volume 14 Issue 8, August 2025, International Journal of Science and Research (IJSR), Pages: 140-143, https://www.ijsr.net/getabstract.php?paperid=SR25801113157, DOI: https://dx.doi.org/10.21275/SR25801113157