Vitamin D receptor genetic polymorphisms are associated with oral lichen planus susceptibility in a Chinese Han population.

BACKGROUND: Vitamin D receptor (VDR) is involved in multiple immune-mediated disorders including oral lichen planus (OLP). This study investigated the association between VDR gene polymorphisms and the risk of OLP. METHODS: In total, 177 OLP patients and 207 healthy participants were recruited from the Affiliated Hospital of Stomatology, Nanjing Medical University. Eight single nucleotide polymorphisms (SNPs: rs731236, rs739837, rs757343, rs2107301, rs2239185, rs7975232, rs11574129 and rs11568820) in the VDR gene were selected and genotyped. RESULTS: The results showed that OLP risk was increased in subjects with the rs2239185 TT genotype (Recessive model: adjusted Odd ratio(OR) = 2.68, 95% Confidence interval(CI) = 1.28-5.62, P = 0.009) and rs7975232 CC genotype (Recessive model: adjusted OR = 2.25, 95% CI = 1.10-4.58, P = 0.026). Moreover, rs2239185 and rs7975232 (P < 0.01) showed significant cumulative effects on OLP risk.Haplotype analysis showed that the CC haplotype (rs2239185-rs7975232) was associated with an increased risk of OLP (OR = 3.11, 95% CI = 1.42-6.83, P = 0.005), compared with the AC haplotype. CONCLUSION: The rs2239185 and rs7975232 variants of VDR may influence OLP susceptibility, and VDR gene polymorphisms may be candidate susceptibility regions for OLP in a Chinese Han population.

Prevalence of bilateral 'mirror-image' lesions in patients with oral potentially malignant epithelial lesions.

Early detection of oral potentially malignant epithelial lesions (PMELs) is aimed at improving survival rates as carcinogenesis is a multistep process and prevention is possible if these lesions are detected at an early and reversible stage of the disease. A prospective clinical study aimed at determining the prevalence of bilateral 'mirror-image' oral PMELs was carried out. Sample consisted of 32 (53.3%) Indians, 23 (38.3%) Chinese, 4 (6.7%) Malays and one (1.7%) Nepalese. All had histopathological confirmation of their primary existing PMEL as inclusion criteria. A total of 70 primary lesions were detected. The most common PMEL found was oral lichen planus. Of these, 28 (46.7%) patients exhibited bilateral 'mirror-image' lesions (n = 42) either synchronously (n = 32/42) or metachronously (n = 10/42). The remaining 32 (53.3%) patients had normal-looking contralateral mucosa. Present findings suggest that patients presenting with oral PMELs are at greater risk of developing a second lesion, most probably in the contralateral 'mirror-image' site.

Salivary and serum interleukin-18 in patients with oral lichen planus: a study in an ethnic Chinese population.

The purpose of this study was to investigate the potential pro-inflammatory role of the cytokine interleukin (IL-18) in oral lichen planus (OLP) so as to provide a reliable and early indicator for the diagnosis of OLP. One hundred three ethnic Chinese patients with OLP were enrolled in this study, as were 48 age- and sex-matched controls. IL-18 concentrations in serum and saliva were screened by enzyme-linked immunosorbent assay. The protein content was expressed as picograms per milliliter. OLP patients showed a high-level of IL-18 expression profile in serum compared with the control group (OLP = 21.32 ± 8.26 pg/mL, control = 12.29 ± 5.11 pg/mL, P < 0.05), and the saliva partner had significantly higher concentrations of IL-18 compared to the control (OLP = 20.12 ± 5.78 pg/mL, control = 15.60 ± 4.17 pg/mL, P < 0.05). In patients with OLP, serum and salivary IL-18 are elevated, correlating with the severity of illness. These findings may be considered to improve the predictive or prognostic values of inflammatory cytokines for OLP and also to design possible novel therapeutic approaches.

Association of interleukin-8 gene polymorphisms and haplotypes with oral lichen planus in a Chinese population.

Interleukin-8 (IL-8), a CXC chemokine with multiple biological functions, plays an important role in the pathogenesis of oral lichen planus (OLP). The aim of this study was to investigate the association of single nucleotide polymorphisms (SNPs) of IL-8 gene with OLP in a Chinese population. Four SNPs of the IL-8 gene at positions -845 T/C (rs2227532), -738 T/A, -251 A/T (rs4073) and +781 C/T (rs2227306) were analyzed in 109 patients with OLP and 101 normal controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The data revealed that the -251 AA genotype and -251 A allele frequency was significantly lower in the erosive OLP (eOLP) group than in the control group (P = 0.012 and P = 0.031, respectively). Haplotype analysis revealed that the -251 A/+781 C haplotype frequency was lower in the eOLP group than in the control group (P = 0.029) while the -251 T/+781 C haplotype frequency was higher in the eOLP patients than in the healthy controls (P = 0.028). The study suggests that the IL-8 polymorphisms may be associated with the severity of OLP in this Chinese cohort.

Association of polymorphisms in the tumor necrosis factor-alpha and interleukin-10 genes with oral lichen planus: a study in a chinese cohort with Han ethnicity.

Cytokines have an important role in the pathogenesis and disease progression on oral lichen planus (OLP). The aim of this study is to investigate the impact of gene polymorphisms of T-helper cell subtype Th1/Th2 cytokines, tumor necrosis factor-alpha (TNF-alpha), and interleukin-10 (IL-10) on OLP in a Chinese cohort with Han ethnicity. Three single-nucleotide polymorphisms (SNPs) of the IL-10 gene (IL-10) at positions -1082G/A, -819C/T, and -592C/A and one SNP of the TNF-alpha gene (TNFG) at position -308G/A were analyzed in 151 patients with OLP and 143 healthy controls using polymerase chain reaction with sequence-specific primers (PCR-SSP) method and polymerase chain reaction-restriction fragment length (PCR-RFLP) method. The data revealed that there was no difference between the OLP patients and healthy control groups in frequencies of both TNF-alpha and IL-10 alleles (P = 0.053) and genotypes (P = 0.197). However, the frequencies of TNF-alpha-308A allele (P = 0.013) in patients with erosive OLP were significantly greater than the corresponding values in the control group. Using PHASE software, four haplotypes were deduced from the three IL-10 polymorphisms -1082 G/A, -819 C/T, and -592 C/A, named haplotypes I to IV. The haplotypes IV, which correlated with a lower serum level of IL-10, has a significant association with OLP (P = 0.008). Our study suggests that TNF-alpha and IL-10 gene polymorphisms seem to have some influence on the disease susceptibility and progression of OLP in this Chinese cohort with Han ethnicity.

Oral lichen planus: a retrospective comparative study between Thai and Croatian patients.

Oral lichen planus (OLP) is a common oral mucosal disease that affects middle age patients. However, there are few reports about the incidence of OLP in different ethnic groups. The purpose of this study was to compare the characteristics of OLP in Thai and Croatian patients. Retrospective data were taken from medical records of 175 patients referred to the Oral Medicine Department of Chulalongkorn University and 175 patients referred to the School of Dental Medicine, University of Zagreb during the 1997-2007 period. In all patients the diagnosis of OLP was clinically and histopathologically confirmed. In Thai and Croatian OLP patients, females were predominant (the female to male ratio was 3.5:1). Croatian OLP patients were older with a significant age difference between female Thai and Croatian OLP patients (p<0.05). Atrophic-erosive type of OLP was common in Thai patients, whereas reticular OLP was predominant in Croatians (p<0.001). Burning sensation was the most common chief complaint in both ethnic groups. Significant differences between the two ethnic groups were found in the sites of OLP lesions as well as in the occurrence of pain, roughness and white patches, systemic diseases and use of medication (p<0.05). Croatian patients had more systemic diseases and took more medications than Thai. Three cases showed dysplasia in either group, whereas only one Thai patient developed squamous cell carcinoma. Although Thai and Croatian patients differed significantly according to the clinical type of OLP, the rate of malignant transformation was very low.

Carriage rate and virulence attributes of oral Candida albicans isolates from patients with oral lichen planus: a study in an ethnic Chinese cohort.

The objectives of this study are to investigate the carriage rate of Candida albicans from the patients with oral lichen planus (OLP, erosive and non-erosive subtypes) and the healthy control individuals in a Chinese cohort and then to compare the virulence attributes of these isolates. Oral C. albicans isolates from 300 patients with OLP as well as 128 healthy controls were isolated and a total of 112 isolates from patients with erosive OLP (62), non-erosive OLP (24) and healthy control (26) were screened for phospholipase activity by using an in vitro plate assay method. Adhesion ability of the above isolates was also studied by using buccal epithelial cells assay. Statistically, the carriage rate of C. albicans from the patients with erosive OLP (44.29%) was higher than that of patients with non-erosive OLP (15.00%) or the healthy control group (20.31%) (P < 0.001). The adhesion to buccal epithelial cells of the isolates from the erosive OLP group (3.950 +/- 1.436) was more marked (P < 0.001) than that from healthy control (2.2112 +/- 0.4833). The phospholipase activity of these isolates either from erosive (0.4170 +/- 0.029) or non-erosive OLP groups (0.4327 +/- 0.028) was higher (P < 0.001) than that from healthy controls (0.5259 +/- 0.074). Some C. albicans isolates with special virulence attributes might be co-factors, which contribute to the development of OLP, especially erosive OLP.

Interleukin-18 gene polymorphisms and haplotypes in patients with oral lichen planus: a study in an ethnic Chinese cohort.

Interleukin (IL)-18, a proinflammatory cytokine, induces T-helper 1 differentiation and cytotoxic T-lymphocyte functions, both of which have been proposed in the pathogenesis of oral lichen planus (OLP) - an oral disease resembles oral mucosal graft-versus-host disease (GVHD) both clinically and histologically. The aim of this study was to evaluate the association of single nucleotide polymorphisms (SNPs) in the IL18 gene on the chromosome 11q22 in patients with OLP. Four SNPs of the IL18 gene at positions -137G/C (rs187238), -607C/A (rs1946518), -656G/T (rs1946519), and 1248A/G (rs189667) were analyzed in 151 patients with OLP and 143 normal controls using polymerase chain reaction-sequence-specific primers method, and the serum level of IL-18 protein was determined by enzyme-linked immunosorbent assay (ELISA). The data revealed that there is a significant difference in IL18-607 genotype distributions between the patient group and the control group (P < 0.001), and the polymorphism -137G/C also appears to be statistically associated with the more severe erosive subtype (eOLP) (P = 0.023). The identified polymorphisms at the IL-18 promoter region (i.e. -137GG) are likely to exert positive effect on the production of IL-18 protein in OLP, as detected by ELISA. Using phase software, four haplotypes were deduced from the two polymorphisms -607C/A and -137G/C, named haplotypes I to IV, and the haplotypes I, II, and IV are significantly associated with OLP (P < 0.001). Our data suggest that the identified IL18 polymorphisms may be associated with the pathogenesis of OLP in this Chinese cohort by upregulation of IL-18 production in vivo.

Líquen plano erosivo: relato de caso / Erosive labial lichen planus: case report

Os autores reportam um caso de líquen plano erosivo bucal, com ênfase aos aspectos etiopatogênicos e terapêuticos. Embora haja controvérsias, o estresse tem sido considerado como um dos fatores predisponentes para o desenvolvimento da doença. No presente trabalho, o tratamento com corticosteróides tópico e sistêmico, não foi eficaz. O paciente foi encaminhado para psicoterapia hipnótica, como segunda opção terapêutica. Após duas sessões, ocorreu completa remissão clínica das lesões bucais, bem como melhora de outros sintomas sistêmicos concomitantes, relatados pela paciente. A relação entre o estresse e o desenvolvimento do líquen plano bucal, bem como o papel do controle emocional na melhora do quadro clínico é discutido. A importância do acompanhamento periódico da paciente é enfatizada, no sentido de se detectar possível exacerbação da doença

Accumulation of oligoclonal T cells in the infiltrating lymphocytes in oral lichen planus.

BACKGROUND: Identification of a disease-specific and possibly pathogenic T-cell receptor (TCR) in oral lichen planus (OLP) is one of the most important steps to reveal the pathogenic antigen recognized by the T cells and thereby elucidate the pathogenesis and etiology of OLP. METHODS: In buccal mucosa biopsy specimens and peripheral blood mononuclear cells (PBMC) from seven patients with OLP, the TCR V beta gene usage was examined by polymerase chain reaction-based and single-strand conformation polymorphism analyses. RESULTS: The V beta families expressed in the biopsy specimens were markedly heterogeneous, but they were restricted in comparison to those observed in the PBMC. The V beta families predominantly expressed in the biopsy specimens in comparison with the PBMC were still heterogeneous in individual patients and differed from patient to patient; however, V beta 2, V beta 6, and V beta 19 were commonly predominant in the biopsy specimens from more than half of the patients. Among the V beta families predominantly expressed in the biopsy specimens, the accumulation of T-cell clonotypes was observed in the majority of the V beta families including V beta 6 and V beta 19; however, it was not observed in the minority of the V beta families including V beta 2. CONCLUSIONS: These results suggest that unique T-cell populations bearing V beta 2, V beta 6, or V beta 19 gene products tend to expand in OLP lesions as a consequence of in situ stimulation with a restricted epitope of either a nominal antigen on the MHC molecule for the majority of the V beta families, even if only in minor populations, or of a common superantigen for the minority of the V beta families.

Clinical characteristics and treatment of patients with oral lichen planus in Israel.

Oral lichen planus (OLP) has a multiple-site involvement, with the buccal mucosa being the most prevalent. A possible relationship between OLP and the risk of malignancies in the involved site is documented. The characteristics of OLP have been studied in different populations; however, no similar studies have been conducted in any Jewish population. The purpose of this study was to evaluate the natural history of OLP in Israeli Jewish patients. Data were collected from 157 charts of patients with histologically confirmed OLP. No evidence suggesting a connection between OLP and diabetes, cardiovascular disease, smoking, alcohol use, or positive Candida culture was found. Skin involvement of lichen planus was found in one fifth of the patients. Symptomatic OLP was noted in half of the patients, mainly in those with the erosive form. In 65% of the patients with symptoms, improvement by more than 50% was shown within 2 weeks of steroid use. The transformation rate of 1.3% of OLP into malignancy was observed in the entire group. A constant follow-up for contributing symptoms and for early diagnosis of suspected transformed lesions is of utmost importance.

Serologic and molecular analysis of the HLA system in Israeli Jewish patients with oral erosive lichen planus.

Oral erosive lichen planus is a distinct subtype of the common dermatosis lichen planus. Although the etiology of lichen planus is still obscure, it is known that cell-mediated immune mechanisms and genetic factors underlie its pathogenesis. Previous studies have found an association between lichen planus and HLA-DR3 or DR9 in different population groups. The present work was designed to elucidate, at the serologic and molecular levels, whether and which HLA genes are associated with oral erosive lichen planus in Israeli Jewish patients. A significant association with HLA-DR2 (RR = 4.7; pc < 0.0013) and a decrease in DR4 (RR = 0.3; p < 0.03) among the patients were noted. Oligotyping of DR2 alleles showed the presence of all three common variants (DRB1*1501, DRB1*1502 and DRB1*1601) in the patients, although none of the variants was overrepresented significantly. Three possible explanations for the role of HLA genes in the predisposition to oral erosive lichen planus are discussed. The most attractive theory for the pathogenesis of the disease seems to include the involvement of non-classical HLA genes.