Assessment of Anti-cancerous Effect of Green, Roasted and Decaffeinated Coffee on Oral Squamous Cell Carcinoma Cell Line
Phase: NA
Conditions: Oral Squamous Cell Carcinoma
Sponsor: Cairo University

Assessment of Anti-cancerous Effect of Green, Roasted and 
Decaffeinated Coffee on Oral Squamous Cell Carcinoma Cell 
Line  
(In Vitro Study) 
2ش 
Presented by 
Asmaa Emad El-Din Mohammed Rashad 
June  2018 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

  
 
 
 
Protocol Checklist 
Section and topic 
Item 
no. 
Checked item 
Reported on 
page No. 
I. Administrative 
information 
1 
Title 
1 
2  
Protocol registration 
1 
3 
Protocol version 
1 
4 
Funding 
1 
5 
Roles and responsibilities 
1 
 
II. Introduction 
6a  
Scientific background 
2 
6b  
Specific objectives 
2 
 
III. Methods 
A) 
Samples, 
intervention 
and 
outcomes 
7  
Calculated sample size  
5 
8  
Description of samples  
5 
9 
The intervention for each group  
5 
10  
 Outcomes 
6 
B) 
Assignment 
to 
intervention 
 
If randomized report the following: 
 
11  
Sequence generation 
7 
12  
Allocation concealment mechanism 
7 
13  
Implementation 
7 

  
 
C) Blinding 
14  
Blinding 
7 
D) Statistical methods  
15   
Statistical methods for comparisons 
of groups 
7 
 
IV- References 
     
8-9 
 
Evidence based committee (Reviewers) 
Name       
Signature 
Date 
1. 
 
 
2. 
 
 
 
Research plan committee 
Name 
Signature 
Date 
1.  
 
 
2.  
 
 
 
 
 
 
 
 
 
 
 
 

  
 
 
I. Administrative information: 
1. Title: 
Assessment of Anti-cancerous Effect of Green, Roasted and Decaffeinated Coffee on Oral Squamous Cell 
Carcinoma Cell Line  (In Vitro Study) 
2. Protocol registration  
Cairo University, June 2018 
3. Protocol version:  
July 2018, Version (1) 
4. Funding: 
Self-funding. 
5. Roles and responsibilities: 
1- The Principle Supervisor:  
 Professor Dr. Mohsen Kazem, Professor of Oral and Maxillofacial pathology, Faculty of 
Dentistry Cairo University. 
2-The Assistant Supervisor :   
 Dr. Manar Abdulwaniss Mohammed, Lecturer of Oral and Maxillofacial Pathology, Faculty of 
Dentistry Cairo University. 
3-The Investigators: 
 Dr.Esam Rashwan , Assistant Professor and Head of Confirmatory Diagnostic unit VACSERA –
Egypt   
 Asmaa Emad El-Din Mohammed(The Principle Investigator) 
 
 
 
 

  
 
II. Introduction:   
6.a.Scientific background  
          Oral cancer is the sixth most common cancer worldwide (Barrios et al, 2015). Over 90% of all 
identified oral cavity cancers are invasive oral squamous cell carcinomas (OSCCs) (Johnson et al, 2011).  
Primary treatments of OSCC are surgery, radiation therapy, and chemotherapy (da Silva et al, 2012). 
However, anticancer therapies (drugs, irradiation) have undesirable side effects as they may induce 
mutations or irreversible DNA damage killing healthy cells (Ochwang’I et al, 2014).  
    One of the most frequently used alternative therapies is herbal medicine that act as anti-ROS agents 
preventing DNA damage has been used alongside conventional treatment regimens (Li et al, 2016). One 
of the agents that receives particular strong interest is coffee. Coffee is considered as a major source of 
dietary antioxidants; some are present in the green bean, whereas others are generated during roasting.  
Coffee roasting, the process of the heating of green coffee beans transforming them into black coffee 
beans, transforms the chemical and biological properties of coffee beans (Wei et al. 2012 and Jeong et al, 
2013).  
     Regarding oral cancer, some studies reported an association of high coffee consumption to an 
augmented risk of oral cancer (Bundgaard et al, 1995 and Franco et al, 1989) while others showed a clear 
inverse association with the risk of oral cancer (Naganuma et al, 2008 and Hildebrand et al, 2013). 
Recently, there have been reports of a protective effect of coffee consumption on oral cancer from two 
recent meta-analysis (Zhang et al, 2015 and Li et al, 2016). To our knowledge, only two studies were 
done to assess the effect of coffee ingredients (cafestol and kahweol) on oral squamous cell carcinoma 
cell lines (Chae et al, 2014 and Kotowski et al, 2015).  
     Due to these controversial findings concerning the effect of roasted coffee and absence of data on 
unprocessed (green coffee), our study aims to investigate the effect of different coffee beverage as regard 
apoptosis and proliferation carried out in OSCC cell lines. 
 Rationale for carrying out this study: 
The main objective of our study was to evaluate anti proliferative and apoptotic activity of green coffee, 
in comparison to roasted coffee and decaffeinated coffee on cultured OSCC cell line.   
 
 
 
 
 

  
 
PICO 
Patient / Population: Human Oral squamous cell carcinoma cell line 
Intervention1: Green coffee  
Intervention2: Roasted coffee  
Intervention3: Decaffeinated coffee  
Control:  no application  
Outcome: 
Primary outcome 1:  assessment of proliferative activity OSCC cell line treated with coffee using 
ELISA. 
Primary outcome 2: Assessment of apoptotic cell death of OSCC cell line treated with coffee using RT-
PCR.  
Outcome measure  
Measuring  device 
       Measuring unit 
1- Primary1 
Proliferative activity 
ELISA 
Comparative 
(light 
absorbed) numerical value 
1- Primary2 
Apoptotic cell death 
RT-PCR 
Comparative 
(fold 
changes) numerical value 
 
Research question 
 
Do different types of coffee affect proliferation and/or apoptosis of human oral squamous cell carcinoma 
cell line? 
 
 
 
 

  
 
III. Methods 
A) Samples, intervention and outcomes 
1) Material:  
1. 
Cell Lines: 
Oral squamous cell carcinoma cell line (SCC15), purchased form the confirmatory diagnostic unit, R&D 
sector, Vacsera, Cairo, Egypt.  
2. 
Coffee extract: 
Green coffee, roasted coffee and decaffeinated coffee from local Egyptian market, Cairo, Egypt. The 
peels and seeds were manually separated. 
2) Methods: 
Intervention:  
Oral squamous cell carcinoma cell line samples will be cultured with and without the addition of green 
coffee, roasted coffee or decaffeinated coffee extract. 
Collecting Samples: 
Oral squamous cell carcinoma cell lines will be purchased from (veterinary serum & vaccine research 
institute, VACSERA). 
 
Only human cell lines. 
 
Animal cell lines. 
Mixed tumors. 
Sample preparation: 
Cells will be sub-cultured in a 96-well plate. 
Monolayer cells will be incubated for 48 hours at 37ºC in the 5% CO2 incubator. 
-acetic acid (50%-5 micro liter) which 
was added to the wells by a multichannel pipette.  
 

  
 
t for half an hour. 
EDTA buffer (100 μl). 
Measurements:  
a) MTT assay for cellular viability: 
     1. One ml of cells (50,000-100,000 cells/ml) will be plated into each well of 96-well culture plate for 
24 hours before the MTT assay. 
2. 
The cells will be incubated for 24 h in CO2 incubator.   
3. 
After treatment of cells with antibiotics and antifungal for 24-72 h, experimental media will be 
removed, and cells will be washed with PBS.  
4. 
Coffee extracts will be added for cell lines with serial dilutions (100µg/ml, 10µg/ml, 1µg/ml, 0.1 
µg/ml, and 0.01µg/ml), incubated for 48 hours and then will be washed by PBS twice. 
5. 
The cells will be incubated with medium containing 0.5 mg/ml MTT in CO2 incubator at 37ᵒC for 
4 h.  
6. 
The medium will be aspirated, and the formazan product will be solubilized with dimethyl 
sulfoxide (DMSO).   
7. 
Absorbance at 570 nm will be measured for each well using a microplate reader (BioTek,Flx 800). 
 The percentages of cytotoxicity and cell viability are calculated using the following equations:  
% cytotoxicity = 1 - [means absorbance of treated cells/mean absorbance of negative control], % viability 
= 100 - % cytotoxicity. 
Measurement of proliferative activity:  
  Enzyme assay (ELISA) will be used to estimate the inhibitory effect green coffee, roasted coffee, 
decaffeinated coffee on Epidermal growth factor Receptor (EGFR) protein. 
Sample preparation for ELISA: 
      Cell lysis for cell culture samples will be carried by spinning down cells for 15 minutes at 1200 RPM. 
Cell pellets are washed once in cold PBS. Cells are re-suspended in Lysis Buffer to a concentration of 
1.5x106 cells/mL, are incubated for 1 hour at room temperature with gentle shaking. Cells are centrifuged 
at 200 x g for 15 minutes. The supernatant will be diluted at least 50-fold in 1X Assay Buffer (5 μL 
supernatant + 245 μL 1X Assay Buffer) for the assay.  
1. 
Prepared biotin antibody is added to samples in different wells.  

  
 
2. 
Then prepared Streptavidin horseradish peroxidase (HRP) solution is added after washing. 
3. 
Tetramethylbenzidine (TMB) Solution is added to each well and incubated at room temperature. 
Stop Solution is added to each well. Readings will be done at 450 nm immediately 
Apoptosis activity assay:  
     Following treatment with green coffee or roasted coffee or decaffeinated coffee for 24 h, the cells are 
harvested, lysed and tested with RT-PCR using specific primers to estimate the fold change of the gene 
expression of Caspase-3, bax, bcl-xl and p53.   
7. Calculated sample size 
No sample size estimation could be done, as the primary outcome is not a measured outcome. 
8. Description of study sample 
No sample size could be applied on cell line experiments as we generate millions of naturally randomized 
cells. 
9. Intervention for each group 
Green coffee extract will be introduced to the 1st group, while roasted coffee will be added to the 2nd 
group. The 3rd group will be treated with decaffeinated coffee.  
10. Outcomes  
 Apoptosis (Gene expression of Caspase – 3, EGFR). 
Prioritization of 
Outcome 
Outcome 
Method of measurement 
Measuring unit 
Primary1 
EGFR expression using 
ELISA 
Robonek 
P2000 
ELISA reader 
IC 50 μg / ml 
Primary2 
Caspase-3, bax, bcl-xl 
and p53 gene expression 
using RT – PCR  
Rotorgene 
PCR 
system 
Fold change  
FLD=e-∆∆CT 
 

  
 
B)Assignment  to intervention  
This study is non-randomized. 
11. Sequence generation 
Sequence generation is not applied on cell line experiments.  
12. Allocation concealment  
Allocation concealment is not applied on cell line experiments.  
13. Implementation 
Implementation is not applied on cell line experiments.  
C) Blinding  
14. Blinding 
Blinding is not applied on cell line experiments.   
D) Statistical methods  
    Data will be analyzed using IBM SPSS advanced statistics (Statistical Package for Social Sciences), 
version 21 (SPSS Inc., Chicago, IL). Numerical data will be described as mean and standard deviation or 
median and range. Categorical data will be described as numbers and percentages. 
 
 
 
 
 
 

  
 
IV- References: 
1. Barrios, R., Tsakos, G., Gil-Montoya, J.A., Montero, J. and Bravo, M., 2015. Association between 
general and oral health-related quality of life in patients treated for oral cancer. Medicina oral, 
patologia oral y cirugia bucal, 20(6), p.e678. 
2. Bundgaard, T., Wildt, J., Frydenberg, M., Elbrond, O. and Nielsen, J.E., 1995. Case-control study 
of squamous cell cancer of the oral cavity in Denmark. Cancer Causes & Control, 6(1), pp.57-67.  
3. Chae, J.I., Jeon, Y.J. and Shim, J.H., 2014. Anti‐Proliferative Properties of Kahweol in Oral 
Squamous Cancer through the Regulation Specificity Protein 1. Phytotherapy research, 28(12), 
pp.1879-1886. 
4. Silva, S.D., Hier, M., Mlynarek, A., Kowalski, L.P. and Alaoui-Jamali, M.A., 2012. Recurrent oral 
cancer: current and emerging therapeutic approaches. Frontiers in pharmacology, 3, p.149.  
5. Franco, E.L., Kowalski, L.P., Oliveira, B.V., Curado, M.P., Pereira, R.N., Silva, M.E., Fava, A.S. 
and Torloni, H., 1989. Risk factors for oral cancer in Brazil: a case‐control study. International 
journal of cancer, 43(6), pp.992-1000.  
6. Hildebrand, J.S., Patel, A.V., McCullough, M.L., Gaudet, M.M., Chen, A.Y., Hayes, R.B. and 
Gapstur, S.M., 2012. Coffee, tea, and fatal oral/pharyngeal cancer in a large prospective US cohort. 
American journal of epidemiology, 177(1), pp.50-58.  
7. Jeong, J.H., Jeong, H.R., Jo, Y.N., Kim, H.J., Lee, U. and Heo, H.J., 2013. Antioxidant and 
neuronal cell protective effects of columbia arabica coffee with different roasting conditions. 
Preventive nutrition and food science, 18(1), p.30.  
8. Johnson, N.W., Warnakulasuriya, S., Gupta, P.C., Dimba, E., Chindia, M., Otoh, E.C., 
Sankaranarayanan, R., Califano, J. and Kowalski, L., 2011. Global oral health inequalities in 
incidence and outcomes for oral cancer: causes and solutions. Advances in dental research, 23(2), 
pp.237-246. 
9. Kotowski, U., Heiduschka, G., Seemann, R., Eckl-Dorna, J., Schmid, R., Kranebitter, V., Stanisz, 
I., Brunner, M., Lill, C. and Thurnher, D., 2015. Effect of the coffee ingredient cafestol on head 
and neck squamous cell carcinoma cell lines. Strahlentherapie und Onkologie, 191(6), pp.511-517. 
10. Li, Y.M., Peng, J. and Li, L.Z., 2016. Coffee consumption associated with reduced risk of oral 
cancer: a meta-analysis. Oral surgery, oral medicine, oral pathology and oral radiology, 121(4), 
pp.381-389. 
11. Li, Y., Zhu, X., Bensussan, A., Li, P., Moylan, E., Delaney, G. and McPherson, L., 2016. Herbal 
medicine for hot flushes induced by endocrine therapy in women with breast cancer: a systematic 
review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2016.  
12. Naganuma, T., Kuriyama, S., Kakizaki, M., Sone, T., Nakaya, N., Ohmori-Matsuda, K., Nishino, 
Y., Fukao, A. and Tsuji, I., 2008. Coffee consumption and the risk of oral, pharyngeal, and 
esophageal cancers in Japan: the Miyagi Cohort Study. American journal of epidemiology, 
168(12), pp.1425-1432. 

  
 
9 
13. Ochwang’i, D.O., Kimwele, C.N., Oduma, J.A., Gathumbi, P.K., Mbaria, J.M. and Kiama, S.G., 
2014. Medicinal plants used in treatment and management of cancer in Kakamega County, Kenya. 
Journal of ethnopharmacology, 151(3), pp.1040-1055.  
14. Wei, F., Furihata, K., Koda, M., Hu, F., Miyakawa, T. and Tanokura, M., 2012. Roasting process 
of coffee beans as studied by nuclear magnetic resonance: time course of changes in composition. 
Journal of agricultural and food chemistry, 60(4), pp.1005-1012. 
15. Zhang, Y., Wang, X. and Cui, D., 2015. Association between coffee consumption and the risk of 
oral cancer: a meta-analysis of observational studies. International journal of clinical and 
experimental medicine, 8(7), p.11657.