“…Previously, we found that arecoline, a major areca nut alkaloid, could increase human buccal mucosa fibroblasts (BMFs) proliferation resulting in fibrotic change . Moreover, the augmentation of vimentin , cyclooxygenase‐2 , tissue inhibitor metalloproteinase‐1 , plasminogen activator inhibitor‐1 (PAI‐1) , interleukin‐6 , keratinocyte growth factor‐1 , insulin‐like growth factor‐1 , NF‐κB , cystatin C , heat shock protein 47 , heme oxygenase‐1 , S100A4 , and protease‐activated receptor‐1 expression may contribute to the extracellular components (ECM) accumulation in areca quid chewing‐related OSF. Recently, we reported that ZEB1 may participate in the pathogenesis of areca quid‐associated OSF by activating the α‐smooth muscle actin promoter and inducing myofibroblast transdifferentiation from BMFs .…”