Lab‑Modified Sugarcane Protein Protects Teeth in Early Tests
Sugarcane Protein Could Fix the Untold Story in Head and Neck Cancer Care
There is a quiet catastrophe unfolding in the aftermath of head and neck cancer treatment, and it has almost nothing to do with the cancer itself.
In the United States, approximately 60,000 adults are diagnosed with head and neck cancer each year. Thanks to improving treatment regimens, an estimated 500,000 people are living as survivors. Many of them emerge from radiation therapy with a mouth full of problems: dry mouth, degraded enamel, rapid tooth decay, and jawbone damage. Dental disease is present in roughly 40% of head and neck cancer patients before treatment even begins. Nearly a third require dental extractions beforehand. The treatments that save their lives leave their mouths in ruins.
And then the oncologist sends them home. The guidelines say they should see a dentist — there are clear recommendations from ASCO, ACS, NCCN, and ESMO — but a 2024 study in the Journal of Clinical Oncology found that only 50% of head and neck cancer survivors ever receive the post-treatment oral and dental care those guidelines prescribe. The reason is not medical ignorance. It is economics and infrastructure: there are too few trained dental professionals in oncology, and neither public nor private insurance consistently covers these services. The survivor is left to navigate a system that was never designed to catch them.
Gabrielle LeMarier survived alveolar rhabdomyosarcoma diagnosed at age three, with radiation to her neck that stunted the growth of her teeth and jaw. She wrote about what came next: decades of functional impairment, the inability to eat or speak normally, the emotional toll on self-esteem and identity. "A disheartening lesson I learned over the decades of my own dental struggles is that this care requires money," she noted in the JCO article. She was fortunate enough to afford care once it became available. Most are not.
Into this gap, a team of researchers at the Bauru School of Dentistry at the University of São Paulo has developed something interesting. Their artificial saliva — delivered as a mouthwash, gel, or an orodispersible film that dissolves on the tongue — is built around a lab-modified sugarcane protein called CANECPI-5. The protein binds directly to tooth enamel, forming a protective acquired pellicle layer that shields teeth from acid attack. In testing, it reduced bacterial activity and slowed demineralization, the process by which teeth lose calcium and phosphate. It performed best when combined with fluoride and xylitol. In a prior 2021 study, 0.05 mg/ml of the protein outperformed chlorhexidine — the standard antimicrobial mouthwash — against mutans streptococci, the bacteria most closely associated with cavity formation.
The work traces back to the Sugarcane Genome Project (SUCEST), a FAPESP-funded effort in Brazil that identified cystatins, a family of proteins involved in regulating other enzymes. Researchers isolated a sugarcane cystatin, named it CANECPI-1, and then developed a series of optimized variants. CANECPI-5 is the latest iteration. The project involves collaborators from the Federal University of São Carlos (UFSCar), the University of California San Francisco, and Yonsei University College of Dentistry in South Korea. The protein is patented. The team has tested it across multiple delivery formats and is now seeking an industry partner to scale production.
This is not a drug. It is a functional protein product — a biomaterial — with a clear mechanism of action and a genuine clinical application. The researchers are explicit that much work remains before human trials confirm what the in vitro and animal data suggest. But the care gap it would address is not hypothetical. It is documented, measurable, and structural.
Here is the uncomfortable corollary that the researchers do not say aloud: even a perfectly effective CANECPI-5 product faces the same infrastructure problem as everything else in this space. A mouthwash does not help if the survivor cannot afford to see a dentist who knows to prescribe it. An orodispersible film does not help if insurance will not cover it. The science of head and neck cancer survivorship has outrun the system designed to deliver its benefits, and a sugarcane protein will not close that gap on its own.
The JCO paper ends with a call for action: coverage and payment for medically necessary services, expansion of the dental workforce with oncology expertise, and policy changes that treat oral care as a component of cancer care rather than an optional add-on. The researchers in São Paulo are building a tool. Whether it ever reaches the half of survivors who need it most depends on a political question, not a scientific one.
Primary sources: