“…Our findings demonstrated that pepsin, in vitro, at slightly acidic pH of 6.0 and in particular at neutral pH of 7.0 preserves cell survival and induces activation of specific oncogenic markers clinically associated with HNSCC [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 51 , 53 ]. Despite the possible pepsin-related stress toxicity and damage in cancer hypopharyngeal cells at either pH 7.4 or pH 7.0 [ 21 , 24 ], using our model, we provide evidence of the oncogenic effect of pepsin in normal HCs at pH 7.0 or 6.0, in line with other observations by Johnston’s team [ 6 , 25 ].…”