Further oxidation of sulfenic acid results in irreversible conversion to sulfinic and sulfonic acids. therapies over the past two decades. As reviewed here, alterations in redox metabolism occur at all stages of HNSCC management, providing opportunities for improved prevention, early detection, response to therapies, and QOL. Bioinformatics and computational systems biology approaches are key to integrate redox effects with multiomics data from cells and clinical specimens and to identify redox modifiers or modifiable Phellodendrine chloride target proteins to achieve improved clinical outcomes. genotype the positive genotype also increases the risk for HNSCC (225). Genetic variants of cell cycle control gene, hybridization or polymerase chain reaction (PCR), and detection of p16 (a surrogate marker for HPV infection) protein expression with immunohistochemistry [reviewed in Chai (51), Mirghani (206), and Venuti and Paolini (303)]. With each of these methods providing different information and having their own specific limitations, there is currently no consensus on the optimal way to identify HPV-related HNSCC. Detection and Diagnosis: Redox Biomarkers in HNSCC Detection HNSCC patients can present with various precancerous conditions and lesions depending on the tumor location within specific areas of the head and neck. The most common symptoms presented by HNSCC patients include chronic sore throat, difficulty swallowing, a change or hoarseness in the voice, and a lump or sore that does not heal. There are currently no biomarkers for early HNSCC detection. Although preclinical studies to identify possible markers for early cancer detection have been reported (in precancerous lesions leading to increased tumor progression compared with hypomethylation of in Phellodendrine chloride precancerous lesions leading to tumor regression (46, 131). Clearly, the GSH levels and epigenetic DNA methylation are mechanistically connected as S-adenosylmethionine (SAM), the substrate for DNA methyltransferases and other methyltransferase enzymes, is synthesized from methionine, which is also part of the GSH biosynthesis through the redox-regulated transsulfuration pathway (136). Given the redox shifts associated with the etiology of HNSCC supported by the value of utilizing CAT and GSH antioxidant biomarkers for early detection, a need for development of redox positron emission tomography (PET) imaging methods for HNSCC early diagnosis is emerging. This has not yet been explored in preclinical or clinical studies in relation to HNSCC. Such PET imaging probes may include [18F]fluorothymidine probe for H2O2 or other yet unexplored biomarker indicators of redox shifts (48). Treatment: Redox Modulators of Standard of Care and Emerging Therapies for HNSCC Standard of care The treatment plan for patients with HNSCC is determined from three parameters: (i) location of tumor, (ii) stage of cancer, and (iii) person’s age and overall performance status regardless of HPV status (89, 92). Surgery followed by fractionated radiotherapy is the standard of care for resectable primary and secondary malignancy with the goal of obtaining tumor-free surgical margins (132). However, negative surgical margins often result in removal of normal tissue causing impairment of critical functions, such as chewing and swallowing, and an adverse QOL (132). In many cases, due to CD36 presence of high risk of relapse factors such as positive margins and/or the presence of extracapsular invasion of the positive lymph nodes by cancer cells, surgery is followed up with aggressive CRT to kill remaining tumor cells. Patients generally undergo fractionated doses of 2?Gy each in 5 weekly sessions for 6C6? weeks for a total dose of 60C66?Gy (27). Patients with unresectable tumors or on whom an organ sparing approach is possible receive radiation therapy (RT) or most often CRT with an even higher dose of RT of 70C72?Gy for 7 weeks (116). Based on large randomized clinical trials and meta-analysis, cisplatin is considered the standard radiosensitizing agent for definitive or adjuvant RT. When used in combination with radiotherapy, cisplatin is given at 100?mg/m2 every 3 weeks during the course of RT (15). However, in recurrent tumors or for palliative care, other chemotherapeutics such as taxanes, hydroxyurea, and the antifolates methotrexate or pemetrexed have been utilized as well as radiosensitizers (129, 258). Antifolates, such as methotrexate and the newer drug pemetrexed, were reported to Phellodendrine chloride sensitize tumors to RT in both preclinical and clinical studies (149, 199, 257). These drugs inhibit the enzyme dihydrofolate reductase, which is essential for DNA synthesis and connects the 1-C/folate metabolism to NAD(P)H/NAD(P)+ balance, GSH biosynthesis, ROS and epigenetics through biosynthesis of SAM, a substrate for DNA methyltransferases, already described. Consistent with this notion, methotrexate also exhibits potent immunosuppressant activity through ROS accumulation and decreased GSH biosynthesis (234). Normal tissue toxicities associated with methotrexate or pemetrexed therapy are typically reduced in the clinic by coadministration of folate/B9 and vitamin B12 products, without reducing the efficiency of treatment (41, 69, 219). What each one of these chemotherapeutics have in common is the link with.