The Use of Buccal Micronucleus Assay for Biomonitoring Systemic Lupus Erythematosus: Is it Possible?

Sir,

We read the manuscript recently published by Assiri et al.[1] in the Indian Journal of Dermatology titled “Correlation of Buccal Micronucleus with Disease Activity Score Using Buccal Micronucleus Cytome Analysis (BMCA) in Systemic Lupus Erythematosus” with much interest. In this article, the authors failed to detect high frequencies of micronucleus in patients suffering from systemic lupus erythematosus. In addition, no correlations, such as micronucleus frequency and disease activity/duration were achieved. However, it is important to properly discuss the scientific approach for a correct understanding of the paper.

In Materials and Methods, it was stated “MN frequencies were determined from a total of 1,000 cells.” In the following paragraph, it was mentioned, “An average of 2,000 epithelial cells was observed for each individual.” In fact, how many cells were evaluated per individual? This needs clarification. Moreover, it was written, “Scoring criteria for the various distinct cell types and nuclear anomalies were evaluated in the BMCA, as described by Tolbert et al.[2]” Nevertheless, what cell types and nuclear anomalies other than micronucleus were evaluated in the study? It is important to emphasize that Tolbert et al.[2] have described several metanuclear changes indicative of cellular death (cytotoxicity) for the buccal micronucleus assay, such as pyknosis, karyorrhexis, and karyolysis. The approach is very interesting because cytotoxicity is potential for bias in the micronucleus assay. For example, if cytotoxicity is increased, then the micronucleus frequency decreased because micronucleated cells are lost as a result of cellular death. Certainly, the disease and/or therapy are able to induce cytotoxicity in mammalian cells.

Finally, although some correlations were performed, as for example, micronucleus and disease activity (P = 0.079) or duration of systemic lúpus erythematous (P = 0.934), where were these data presented in the manuscript? Certainly, this is very important to evaluate the paper with accuracy.

We believe that these comments are useful for a better understanding of the important article for biomonitoring patients with systemic lupus erythematous.

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Conflicts of interest

There are no conflicts of interest.