遗传性牙龈纤维瘤病的临床特点及致病基因检测

目的检测分析遗传性牙龈纤维瘤病（hereditary gingval fibromatosis,HGF）患者的临床特点及致病基因。方法收集HGF家系1个,采用先证者查证法对其家庭成员进行全身健康状况及口腔专科检查。收集患者及健康牙龈组织作HE和Masson染色进行组织学检查。抽取患者及正常家族成员的静脉血,提取基因组DNA,PCR扩增SOSI基因并测序,同源性比较分析（basiclocalalignmentsearchtool,BLAST）。结果患者牙龈组织HE染色显示典型牙龈纤维瘤病的组织病理表现,Masson染色显示胶原纤维较正常人丰富。SOSl基因突变检测未发现突变点。结论HGF具有高度遗传异质性,目前被成功克隆与鉴定的致病基因SOSl不是唯一的致病基因。     

Hereditary gingival fibromatosis with a recessive mode of inheritance. Case reports

Hereditary gingival fibromatosis is characterized by varying degrees of attached gingival hyperplasia and may in rare cases present as a feature of a generalized syndrome. It is usually inherited as an autosomal dominant condition though recessive forms are described. The dental and genetic features of an affected brother and sister with a probably unique autosomal recessive hereditary fibromatosis syndrome are presented.     

遗传性牙龈纤维瘤病（附2例报告）

目的通过探讨遗传性牙龈纤维瘤病（HGF）的临床特点及治疗方法,增进对本病的认识,从而提高诊断治疗水平。方法先证者法收集两个HGF家系全部成员资料,观察不同家系及同一家系不同个体的临床表型和发病特点,绘制系谱图,分析可能的遗传方式。对两名先证者采用手术治疗。结果两家系发病患者均符合非综合征型HGF特征。发病患者不同个体间的表现度不同。两家系均符合常染色体显性遗传特征。经随访,手术患者治疗效果良好。结论 HGF遗传方式以常染色体显性遗传为主,且同一家系的不同受累个体其增生程度轻重不一,极具差异,具有高度遗传异质性。手术是治疗该病的有效的方法。     

遗传性牙龈纤维瘤病的临床研究

目的探讨遗传性牙龈纤维瘤病(hereditary gingival fibromatosis,HGF)的临床特征。方法回顾分析我院2001-2007年收治的3例HGF病例,对其遗传特点及相关的综合征,临床表现,X线片特征,组织病理,诊断分型及治疗预后进行分析。结果3例HGF患者1例为综合征型HGF,2例为非综合征型HGF,其遗传特性、发病年龄、临床表征各有所不同,但均具有典型全口牙龈增生及牙槽骨吸收。结论3例HGF不同个体表现不尽相同,具有一定的异质性。     

Increased expression of integrin α2 and abnormal response to TGF-β1 in hereditary gingival fibromatosis

Objective:  To investigate the possible correlation between integrin α1, α2, and β1 expression and excessive collagen synthesis in fibroblasts from 3 unrelated Chinese families with hereditary gingival fibromatosis (HGF).
Design:  Gingival fibroblasts from three Chinese HGF patients and three healthy subjects were included. The expression of α1, α2, and β1 integrin subunits was examined by immunohistochemistry, quantitative PCR, and flow cytometry. We also investigated the effects of transforming growth factor-β1 (TGF-β1) on the expression of these integrin subunits.
Results:  Our results demonstrate that the expression of α2 was significantly higher in HGF fibroblasts compared with control fibroblasts ( P  < 0.01). No significant differences in the expression of α1 and β1 were detected. Furthermore, TGF-β1 promoted the expression of α1 and α2 in fibroblasts from both HGF patients and controls. However, it had a larger effect on the expression of α2 in HGF fibroblasts than in control cells. In contrast, α1 expression was stimulated more in control fibroblasts.
Conclusion:  The increased expression of integrin α2 and the increased response to TGF-β1 of HGF fibroblasts may be related to the excessive collagen deposition in HGF patients.     

Nonsyndromic hereditary gingival fibromatosis: Characterization of a family and review of genetic etiology

Our aim is to describe a family with a nonsyndromic form of hereditary gingival fibromatosis (HGF) and discuss genetic characteristics of this rare disease by reviewing reported cases. A mother and three descendants were diagnosed with HGF. There was marked variable expressivity: from severe generalized gingival overgrowth in a 16-year-old boy (the proband) to minimal manifestations in the mother. The proband was submitted to gingivectomy and gingivoplasty. In younger siblings, the disease remained stable for 5 years, suggesting that clinical surveillance is a good option. The diagnosis was supported by histopathological examination. Analysis of this family and literature-reported cases supports that HGF most frequently shows an autosomal dominant inheritance with high penetrance and variable expressivity. Neomutations and gonadal mosaicism do not seem to be a rare event. Although five loci have been mapped by linkage analysis, only two genes, SOS1 and REST, were identified in four families.     

Further evidence of genetic heterogeneity segregating with hereditary gingival fibromatosis

Aim: To clinically characterize and map the disease-associated locus in a five-generation Chinese family with autosomal dominant early-onset hereditary gingival fibromatosis (HGF).
Material and Methods: A complete oral examination was conducted. Genomic DNA samples were obtained from 14 individuals. Short tandem repeats markers, which encompass four previously known loci related to HGF, were genotyped. Two-point log of the odds (LOD) scores were calculated using MLINK program of the LINKAGE software, multipoint and non-parametric linkage (NPL) analysis were performed using the GENEHUNTER software.
Results: Clinical evaluation and histological examination of this family suggested typical features of HGF. The onset age was early in the generations, ranging between 1 and 2 years. None of the tested markers showed cosegregation among affected individuals. Genotyping data from four putative regions yielded significant negative two-point LOD scores (<−2.0) at θ=0. The maximum multipoint LOD scores and NPL analysis revealed exclusion of these loci as well.
Conclusions: Exclusion of linkage in this family to any of the known HGF loci proved the existence of a novel locus for autosomal dominant HGF and showed that this rare disorder is far more heterogeneous than previously expected.     

白细胞介素-1β对遗传性牙龈纤维瘤和正常牙龈上皮细胞β-防御素的影响

目的:比较白细胞介素1β(IL-1β)刺激体外培养的正常牙龈、遗传性牙龈纤维瘤(HGF)上皮细胞β-防御素(HBD)表达的差异,探讨该差异与遗传性牙龈纤维瘤发病机制的可能相关性。方法:体外培养3例遗传性牙龈纤维瘤病人和6例正常人牙龈上皮细胞,经0,0.01,0.1,1,10,100 ng/mL的IL-1β分别刺激12、24、36、48 h,提取细胞总RNA,逆转录后,采用HBD-1、2、3特异性引物经PCR扩增,以β-肌动蛋白为内参,计算HBD-1、2、3与内参扩增产物相对值,对HBD-1、2、3进行半定量分析,采用SPSS软件单向方差统计分析法分析结果。结果:HBD-1 mRNA在正常牙龈和遗传性牙龈纤维瘤上皮细胞中呈固有表达,不受IL-1β刺激的影响。IL-1β可上调两种牙龈上皮细胞HBD-2、3的表达,在浓度为0.1～10 ng/mL时,作用时间大于12 h,受刺激组与未受刺激组差异有显著性(P<0.01)。相同浓度IL-1β作用不同时间时,正常牙龈上皮细胞中HBD-2、3的表达水平显著高于遗传性牙龈纤维瘤上皮细胞中表达水平(P<0.05,P<0.01)。且随作用时间延长差异更加显著。结论:遗传性牙龈纤维瘤病变组织和正常牙龈组织中β-防御素的表达有差异,这种差异可能与遗传性牙龈纤维瘤上皮细胞的分化及发病机制相关。     

Differential proliferation of fibroblasts cultured from hereditary gingival fibromatosis and normal gingiva

Hereditary gingival fibromatosis (HGF) is an oral condition characterized by the enlargement of the gingiva of both the maxilla and mandible. To study the cell proliferation index of fibroblasts from HGF and normal gingiva (NG), cell cultures from 4 members of the same family with HGF and from 4 healthy patients were established. Our results obtained from 6 different cell proliferation assays clearly showed that the cell proliferation rate was significantly higher in fibroblasts from HGF than from normal gingiva. HGF and control fibroblasts in subconfluent culture densities were typically spindle, but in saturation density HGF cells were shorter than control cells. These data suggest that the higher proliferative index of HGF fibroblasts possibly has a role in the pathogenesis of gingival outgrowth in HGF patients.     

Familial gingival fibromatosis; no correlation with HLA-antigen A family study

Familial gingival fibromatosis is generally reported to be inherited as an autosomal dominant trait. We investigated 2 families with few siblings affected with gingival fibromatosis. No linkage between HLA antigen and the phenomenon was found. These results support the idea of the autosomal dominant nature of familial gingival fibromatosis.     

Hereditary gingival fibromatosis in a family with the Zimmermann Laband syndrome

Hereditary gingival fibromatosis is frequently an isolated condition of little consequence apart from a cosmetic problem and occasional associations with hypertrichosis and/or epilepsy. There are, however, several uncommon or rare eponymous syndromes described in which gingival fibromatosis can be a feature: these include the Zimmermann-Laband, Murray-Puretic-Drescher, Rutherfurd, Cowden and Cross syndromes. This paper describes two siblings with features of the rare Zimmermann-Laband syndrome and discusses the major aspects of this and other eponymous syndromes that may be associated with hereditary gingival fibromatosis.     

Lack of pathogenic mutations in SOS1 gene in phenytoin-induced gingival overgrowth patients

ObjectiveGingival overgrowth is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressants, and calcium channel blockers. One of the main drugs associated with gingival overgrowth is the antiepileptic phenytoin, which affects gingival tissues by altering extracellular matrix metabolism. It has been shown that mutation of human SOS1 gene is responsible for a rare hereditary gingival fibromatosis type 1, a benign gingival overgrowth. The aim of the present study is to evaluate the possible contribution of SOS1 mutation to gingival overgrowth-related phenotype.DesignWe selected and screened for mutations a group of 24 epileptic patients who experienced significant gingival overgrowth following phenytoin therapy. Mutation scanning was carried out by denaturing high-performance liquid chromatography analysis of the entire coding region of the SOS1 gene. Novel identified variants were analyzed in-silico by using Alamut Visual mutation interpretation software, and comparison with normal control group was done.ResultsMutation scanning of the entire coding sequence of SOS1 gene identified seven intronic variants and one new exonic substitution (c.138G > A). The seven common intronic variants were not considered to be of pathogenic importance. The exonic substitution c.138G > A was found to be absent in 100 ethnically matched normal control chromosomes, but was not expected to have functional significance based on prediction bioinformatics tools.ConclusionsThis study represents the first mutation analysis of the SOS1 gene in phenytoin-induced gingival overgrowth epileptic patients. Present results suggest that obvious pathogenic mutations in the SOS1 gene do not represent a common mechanism underlying phenytoin-induced gingival overgrowth in epileptic patients; other mechanisms are likely to be involved in the pathogenesis of this drug-induced phenotype.     

Morphological and molecular analysis of idiopathic gingival fibromatosis: a case report

AIM: We analyse a case of idiopathic gingival overgrowth using morphological and molecular methods. As this overgrowth involves collagen accumulation in the gingival connective tissue, we measured the collagen turnover to clarify the pathogenic mechanisms potentially involved. MATERIALS AND METHODS: The patient was a 29-year-old Italian woman with enlargement of the gingivae throughout the entire mandible and maxilla. Morphological analyses were carried out on haematoxylin-eosin and Sirius red-stained paraffin-embedded gingival sections. mRNA levels of collagen type I and III, matrix metalloproteinase (MMP)-1, transforming growth factor-beta1 and lysyl hydroxylase (LH)2b were determined by RT-PCR on cultured gingival fibroblasts and compared with healthy control fibroblasts. Interstitial collagen and MMP-1 content in the supernatants were assessed, respectively, by dot blot and SDS zymography. RESULTS AND CONCLUSIONS: In Sirius red-stained sections of the patient's overgrown gingivae, interstitial collagen content was 29% higher than controls. Her gingival fibroblasts had higher collagen type I, MMP-1 and LH2b gene expression and unmodified interstitial collagen, type I protein levels in the supernatants. These findings would seem to suggest that in this case collagen accumulation in the gingival connective tissue was not associated with increased synthesis and decreased degradation.