Abnormal EBV immune status in oral lichen planus

OBJECTIVE: To investigate any possible association between oral lichen planus (OLP) and the humoral immune response to Epstein-Barr virus (EBV). MATERIAL AND METHODS The population consisted of 22 patients with histologically verified OLP and 22 healthy sex- and age-matched controls without any oral mucosal diseases. Specific serum IgG antibodies (Ab) towards EBV early antigen (EA) and nuclear antigen-I (EBNA) and IgM Ab towards EBV EA were determined by ELISA.
RESULTS: The optometric density (OD) IgG anti-EA Ab levels were significantly higher in OLP patients than in controls and a significantly negative correlation between duration of symptoms from OLP and IgG anti-EA OD Ab values was demonstrated. IgM anti-EA and IgG anti-EBNA OD Ab levels were not significantly different between the two groups.
CONCLUSION: The hypothesis of any possible association between EBV and OLP has never been tested but the present results seem to lend support for an aberration in the humoral response to EBV in OLP patients.     

口腔扁平苔藓的分型治疗思路

口腔扁平苔藓病损类型复杂多样,仅采用单一的治疗方案难以获得良好的控制效果,本文将对其进行分类细化至各个亚型,并对各型的治疗思路进行较详细地梳理和解析。     

口腔扁平苔藓基因表达谱中差异表达基因初步探讨

目的筛选口腔扁平苔藓组织中的差异表达基因,并对其进行功能分类。方法用4 000种人类基因多聚酶链反应产物制成BiostarH- 40s型表达谱芯片,分离纯化正常口腔黏膜组织和口腔扁平苔藓病变组织mRNA,制备表达谱探针,用ScanArray 4000 荧光扫描仪扫描芯片荧光信号图像,分析正常口腔黏膜组织和口腔扁平苔藓组织之间差异表达的基因。结果1）在4 000条基因中,有213条基因表达差异,其中122条基因表达上调,91条基因表达下调。2）在表达上调基因中,功能分类主要包括免疫相关基因、代谢相关基因、癌基因、细胞因子、细胞信号和传递蛋白。3）在表达下调基因中,功能分类主要包括DNA结合、转录和转录因子、细胞信号和传递蛋白、免疫相关基因、细胞因子、代谢相关基因。结论口腔扁平苔藓的发生、发展过程中存在着多条不同功能基因表达调控的改变。     

A clinical study of 674 patients with oral lichen planus in China

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular, atrophic or erosive. Although OLP is a relatively common disorder, the reports comprising large numbers of OLP patients with specific character are lacking in the literature. The purpose of this paper was to describe the clinical characteristics of OLP in 674 Chinese patients. METHODS: A total of 674 charts of patients with histologically confirmed OLP were collected from Stomatological Hospital of Wuhan University between 1963 and 2003. RESULTS: Of the 674 patients, 65.9% were women and 34.1% were men. The most common clinical presentation was the reticular type (51.3%), and symptomatic OLP was noted in 67.5% of the patients, mainly in those with the erosive form. The erosive presentations showed significantly longer duration, more sites affected and a much greater old patients predominance than reticular or atrophic ones. About 90.9% of the patients had multiple oral sites of involvement and isolated lower lip lichen planus were observed in 60 cases (8.9%) and isolated gingiva lichen in only one case (0.2%). Skin involvement of lichen planus was found in 11.4% of patients. No statistically significant differences could be identified between OLP and diabetes, cardiovascular disease, smoking or alcohol use. Precipitating factors that resulted in an exacerbation of the disease were frequently noted and included foods, stress, dental cusp and poor oral hygiene. The transformation of OLP into malignancy was observed in four patients at sites previously diagnosed by clinical examination as erosive or atrophic lichen planus. CONCLUSIONS: Patients with OLP in China usually present with distinctive clinical morphology and characteristic distribution and few may display lesions with a confusing array of forms mimicking other diseases. A long time follow up is of utmost importance to detect its malignant transformation.     

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口腔扁平苔藓(orallichenplanus,OLP)是一种累及口腔黏膜且可反复发作的慢性炎症疾病,患病率为0.51%,在口腔黏膜疾病中居第2位,属常见病。皮肤和黏膜可单独或同时发病,病理表现相似:主要以口腔黏膜不同程度的角化异常、基底层细胞液化变性、上皮下结缔组织中淋巴细胞呈带状浸润为典型表现。     

Psychological profile in oral lichen planus

AIM: Oral lichen planus (OLP) is an oral lesion with an enigmatic etiology. To explore the possibility of psycho-somatization, we evaluated the psychological personality profiles of OLP patients. METHODS: Twenty patients with reticular; 20 with erosive form of OLP, and 25 controls were tested with the psychological Minnesota Multiphasic Personality Inventory (MMPI)-202 test. Eight clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia, and hypomania) as well as cortisol level, CD3, CD4, CD8, and CD16 markers by group were compared. Psychosomatization was evaluated by the use of internalization ratio (IR) Index. RESULTS: A characteristic MMPI profile was noted in the OLP groups with high IR index value. Significant differences among the groups were detected for cortisol, CD4, CD8, and CD16 counts. Mean values for hypochondriasis, depression, and hysteria were all significantly different with significantly higher mean scores for both reticular and erosive OLP subjects compared with controls. CONCLUSIONS: Prolonged emotive stress in many OLP patients may lead to psychosomatization and may contribute to the initiation and clinical expression of this oral disorder. Clinical significance: If additional research involving a larger and more diverse sample of patients confirms these findings, clinical trials will be needed to determine whether adjunctive psychological intervention provides a benefit in treating patients with OLP.     

Inflammation‐related cytokines in oral lichen planus: an overview

Cytokines are powerful mediators which play a central role in both innate and adapted immune responses. Aberrant productions of cytokines may lead to the onset of immune deficiency, allergy or autoimmunity, which are involved in the mechanisms of various immune‐mediated inflammatory diseases. Oral lichen planus (OLP) is a chronic inflammation disease affecting the oral mucosa with unknown aetiology. Previous studies have described the abnormal expression patterns of various inflammation‐related cytokines, such as IL‐1, 2, 4, 5, 6, 8, 10, 12, 17, 18, TGF‐β, IFN‐γ and TNF‐α, in lesions, saliva, serum and peripheral blood mononuclear cells from patients with OLP, which may reflect the immune dysregulation status and emerge as central players in the immunopathogenesis of OLP. Besides, the gene polymorphisms of several cytokines such as IFN‐γ, TNF‐α, IL‐4, IL‐10 have been found to be involved in the susceptibility of OLP. In this review, we gave a brief introduction of the characteristics and biological functions of these inflammation‐related cytokines and summarized for the first time the current knowledge on the involvement of inflammation‐related cytokines in OLP. Further research on the exact roles of these cytokines will aid the understanding of the pathogenesis and the identification of novel therapeutic approaches of OLP.     

不同临床类型OLP中STAT3的表达及意义

目的：研究不同临床类型的口腔扁平苔藓（OLP）中细胞信号传导和转录激活因子3（STAT3）的表达及意义。方法：采用免疫组织化学方法分别检测10例正常口腔黏膜组织,29例非糜烂型OLP、16例充血糜烂型OLP损害中STAT3的表达。结果：STAT3阳性表达分布于细胞质和细胞核内。正常口腔黏膜、非糜烂型OLP、糜烂型OLP上皮层中STAT3阳性表达率分别为30．00％（3/10）、75．86％（22/29）、93．75％（15/16）;固有层中分别为0％（0/10）、65．52％（19/29）、100．00％（16/16）;三种类型上皮层两两之间相比,差异有统计学意义（P＜0．05）;固有层两两之间相比,只有非糜烂型OLP和糜烂型OLP之间差异没有统计学意义（P＞0．05）。结论：STAT3与OLP上皮层的炎症进程密切相关,对STAT3表达的研究将有助于进一步探究OLP的发病机制和早期临床诊疗。     

DNA ploidy in oral lichen planus,determined by image cytometry

J Oral Pathol Med (2010) 39 : 206–211 Background: The objective of this study was to use image cytometry to determine the degree and frequency of DNA ploidy in biopsies of reticular and atrophic‐erosive oral lichen planus and to analyze 14 karyometric measurements of the nuclei of epithelial cells from each specimen. Methods: A total of 40 slides were analyzed, each of them representing one biopsy of one oral lichen planus (OLP) lesion from each one of the 40 patients (cases) studied. Specimens were embedded in paraffin and comprised 20 slides of reticular oral lichen planus (group R) and 20 slides of atrophic‐erosive oral lichen planus (group AE). Results: Group R, the reticular lichen samples, had 18 diploid cases and two aneuploid cases. Group AE, the atrophic‐erosive lichen samples, had 10 diploid cases, one tetraploid case, and nine aneuploid cases. Of the 14 karyometric measurements of the nuclei of OLP epithelial cells analyzed, the group R mean values for mean density and minimum density were significantly greater than the group AE mean values, and mean roundness in group AE was significantly greater than in group R (t‐test: P < 0.05). Conclusions: The most common degree of DNA ploidy in OLP lesions was diploidy. Comparing the two groups (chi‐square test of association P = 0.021) demonstrated that diploidy was associated with the reticular clinical form of OLP, while aneuploidy was associated with the atrophic‐erosive clinical form of oral lichen planus.     

口腔扁平苔藓合并食道扁平苔藓的诊治及相关文献复习

目的总结分析口腔扁平苔藓（OLP）合并食道扁平苔藓（ELP）的临床发生率、诊出方法、治疗和恶变倾向。 方法对236例OLP确诊患者,根据主诉及问诊有胸部不适、胸前灼痛、烧灼感、吞咽困难、食道狭窄、进食不畅等症状,获得知情同意后进一步进行食道胃镜检查及病理活检,筛选合并ELP,进行规范治疗和追踪。 结果18例出现了ELP病损,OLP合并出现ELP发生率为7.6%（18/236）。其中2例11.1%（2/18）早于OLP出现食道非典型增生,1例5.5%（1/18）已早于OLP出现恶变为食道鳞状细胞癌。 结论扁平苔藓是全身性疾病,ELP和OLP均属于黏膜的慢性炎症性疾病,两者间存在关联性。口腔科医生接诊OLP患者时,应该关注其全身其他部位的病损,尽早发现其他部位早期而隐匿的恶变,以免造成误诊和漏诊。     

不同部位口腔扁平苔藓对治疗的不同反应1例

口腔扁平苔藓（OLP）通常在同一患者口内同时出现多个部位的损害。在同一OLP患者口内的多发性病损，大多数对治疗的反应相对一致。本文报道了1例多发性OLP经药物治疗后，患者口内不同部位的病损表现出差异较大的疗效，并对其可能原因进行了分析。     

Th1 cytokines in oral lichen planus

BACKGROUND: Cell-mediated immune responses in oral lichen planus (OLP) may be regulated by cytokines and their receptors. METHODS: In situ cytokine expression and in vitro cytokine secretion in OLP were determined by immunohistochemistry and ELISA. RESULTS: The majority of subepithelial and intraepithelial mononuclear cells in OLP were CD8+. In some cases, intraepithelial CD8+ cells were adjacent to degenerating keratinocytes. CD4+ cells were observed mainly in the deep lamina propria with occasional CD4+ cells close to basal keratinocytes. Mononuclear cells expressed IFN-gamma in the superficial lamina propria and TNF-alpha adjacent to basal keratinocytes. Basal keratinocytes expressed TNF-alpha as a continuous band. TNF R1 was expressed by mononuclear cells and basal and suprabasal keratinocytes. There was variable expression of TGF-beta1 in the subepithelial infiltrate while all intraepithelial mononuclear cells were TGF-beta1-. Keratinocytes in OLP stained weakly for TGF-beta1. Unstimulated OLP lesional T cells secreted IFN-gamma in vitro. TNF-alpha stimulation down-regulated IFN-gamma secretion and up-regulated TNF-alpha secretion. IL-4, IL-10 and TGF-beta1 secretion were not detected. CONCLUSIONS: These data suggest the development of a T helper 1 immune response that may promote CD8+ cytotoxic T-cell activity in OLP.     

Interobserver and intraobserver variability in the clinical assessment of oral lichen planus

BACKGROUND: In 1978, a clinical definition of OLP was formulated by the WHO. To date, the validation results of this clinical definition have not been published. The aim of this study was to evaluate interobserver and intraobserver variability in the clinical assessment of oral lichen planus (OLP). METHODS: Four clinicians examined a set of 159 clinical pictures of a white lesion in a group of 60 patients. Each reviewing examiner was asked to apply the WHO definition of OLP from 1978, and to categorise each case as either: (i) diagnostic of OLP, (ii) other definable lesion, or (iii) leukoplakia. After three months, each of the four reviewing clinicians was given the clinical pictures of 45 randomly retrieved cases from the original 60. Interobserver and intraobserver variability were assessed by calculation of unweighted kappa statistics. RESULTS: Interobserver agreement varied from 0.43 (moderate) to 0.77 (substantial), while the intraobserver agreement varied from 0.62 (substantial) to 0.92 (good). CONCLUSIONS: Although the clinical WHO definition of OLP seems to be more reproducible than the histopathological one, there is still a significant amount of subjectivity in using this definition. A set of clinical and histopathological diagnostic criteria with good interobserver and intraobserver agreements (kappa values > 0.8) is very important in enabling reproducible and reliable studies on OLP to be performed.     

微小RNA在口腔扁平苔藓中的作用

微小RNA家族在调控基因表达中的重要作用日益受到关注,其调控的基因涉及细胞增殖、凋亡、生长、分化和代谢、血管化和免疫应答等多种生物过程,其表达谱和表达量的变化与多种疾病如肿瘤、炎症性疾病、自身免疫性疾病的发生、发展密切相关.本文对口腔扁平苔藓中微小RNA的研究现状作一综述.     

The frequency of Candida in oral lichen planus

ABSTRACT – Histologic material of typical lichen planus lesions from 43 patients was studied. Two sections of each specimen were stained with hematoxylin-eosin and 10 sections by the PAS method. Only 1 of 43 biopsies was invaded by Candida, and hyphae were present in all of the 10 PAS-stained sections of this case. The results show that oral lichen planus has a considerably lesser susceptibility than oral leukoplakia to invasion by Candida albicans.     

玉屏风口服液对口腔扁平苔藓差异表达基因干预的初步探讨

目的 应用基因芯片技术及最新公共数据库,观察玉屏风口服液作用后口腔扁平苔藓(oral lichen planus,OLP)组织中基因表达谱改变。方法 分离纯化正常口腔黏膜组织、口腔扁平苔藓病变组织和服用玉屏风口服液后扁平苔藓病变组织mRNA,制备表达谱探针,混合后用BiostarH-40s型基因芯片杂交,用ScanArray 4000荧光扫描仪扫描芯片荧光信号图像,利用GenePix Pro 3.0软件分析检测玉屏风口服液作用口腔扁平苔藓组织中的差异表达基因,并进行筛选。结果 服用玉屏风口服液后,病变组织有5条基因表达上调,3条基因表达下调,功能以转录基因为主。结论 玉屏风口服液对口腔扁平苔藓的差异表达基因具有干预作用,干预基因以转录基因为主。?     

Pathogenesis of oral lichen planus – a review

J Oral Pathol Med (2010) 39 : 729–734 Oral lichen planus (OLP) is a T‐cell‐mediated chronic inflammatory oral mucosal disease of unknown etiology. OLP presents as white striations, white papules, white plaques, erythema, erosions, or blisters affecting predominantly the buccal mucosa, tongue and gingiva. Both antigen‐specific and non‐specific mechanisms are hypothesized to be involved in the pathogenesis of oral lichen planus (OLP). Antigen‐specific mechanisms in OLP include antigen presentation by basal keratinocytes and antigen‐specific keratinocyte killing by CD8⁺ cytotoxic T cells. Non‐specific mechanisms include mast cell degranulation and matrix metalloproteinase activation in OLP lesions. These mechanisms may combine to cause T cell accumulation in the superficial lamina propria, basement membrane disruption, intra‐epithelial T cell migration and keratinocyte apoptosis in OLP. The various hypotheses proposed for pathogenesis of oral lichen planus are discussed in this review.     

Expression of lymphocyte function-associated antigen 3 in oral lichen planus

OBJECTIVE: The expression pattern of lymphocyte function-associated antigen 3 (LFA-3) in the buccal mucosa of oral lichen planus (OLP) patients was compared to that of healthy controls to investigate the possible role of LFA-3 in cell interactions within OLP lesions.
MATERIALS AND METHODS: Samples of buccal mucosa from 17 clinically healthy individuals and 17 OLP lesions were analysed. Expression of LFA-3, CD2, CD3 and CD 14 was visualized by an immunoperoxidase technique and assessed microscopically.
RESULTS: In healthy buccal mucosa LFA-3 was expressed on keratinocytes, Langerhans cells within the epithelium and on endothelial cells in the lamina propria. In OLP patients a similar pattern of LFA-3 staining was observed. In addition, cytoplasmic LFA-3, without accompanying surface staining, was seen on a subpopul-ation of macrophage-like cells. Substantial amounts of LFA-3 also appeared to be associated with non-cellular components of the extracellular matrix within the inflammatory infiltrate.
CONCLUSIONS: We have obtained evidence for a previously undescribed localization of LFA-3 within macro-phages, and have observed that expression of LFA-3 is apparently elevated within OLP lesions. LFA-3 may play an important role in the pathogenesis of OLP.