Antigen‐presenting cells in human immunosuppressive drug‐induced gingival enlargement

Abstract

An immunoperoxidase technique was used to compare the number of CD1a+ and factor XIIIa+ dendritic cells (DCs), and CD68+ Macrophages (M) in 30 gingival samples from subjects with clinically healthy periodontitium (HP) and 10 samples from subjects with drug-induced gingival enlargement (DIGE). Fewer CD1a+ and factor XIIIa+ DCs were found in areas with inflammatory infiltration (II) of the lamina propria (LP) in the group with immunosuppressed DIGE (IDIGE) compared to the group with HP. In the sulcular and junctional/pocket epithelia, the number of CD1a+ DCs was decreased in the group with IDIGE (p<0.05). There was a tendency toward a reduced number of CD1a+ DCs and CD68+ M in areas without inflammatory infiltrate of the LP in the group with IDIGE. The alterations in the number of antigen-presenting cells (APCs) may be the reason for the decreased periodontal inflammation and breakdown clinically observed in subjects who are immunosuppressed.

Distribution of dendritic cells and langerhans cells in peri-implant mucosa

“…Significant escalation in factor XIIIa DCs in the epithelium of peri-implant mucosa was observed distinguish to HM stating their role in reducing fibroblast proteolytic activity favoring gingival enlargement. [19]…”

Cytology and Molecular Mechanisms of Drug-Induced Gingival Hypertrophy: A Rewiew

“…This molecule is a natural metabolic product of some funguses; it is the main therapeutic agent used to block rejection of any allogeneic transplant; it essentially works by blocking the transcription of cytokines in lymphocytes T. It was isolated for the first time in the Swiss laboratories of "Sandoz", obtained through the fermentation of the Agar broth of two funguses; Cilindrocarpon Lucidum and Trichoderma Polysporum. Initially it was used as an anti-infective agent, then immediately emerged its immunosuppressive qualities (9,10). Cyclosporine is able to suppress the production of interferon and IL-2 by alternating the line of cell mediated support by lymphocytes T. This drug is unwieldy and its therapeutic window is very small, it's metabolized by the microsomal hepatic system, specifically by CYP-450, and then is excreted in the bile (10).…”

“…Initially it was used as an anti-infective agent, then immediately emerged its immunosuppressive qualities (9,10). Cyclosporine is able to suppress the production of interferon and IL-2 by alternating the line of cell mediated support by lymphocytes T. This drug is unwieldy and its therapeutic window is very small, it's metabolized by the microsomal hepatic system, specifically by CYP-450, and then is excreted in the bile (10). Its adverse effects are manifold, including renal hepatic toxicity, neurotoxicity, hypertrichosis and hyper proliferation of the gums.…”

“…The molecular mechanism is rather complex: cyclosporine penetrates the plasma membrane, binds to a cytoskeleton contractile protein: the calmodulin physiologically binds Ca ++ . In this way is inhibited the binding of calmodulin with calcineurina which modulates the reaction of cellular apoptosis (10,11). Resulting in an inhibition of apoptosis with increased number of fibroblasts which, because of intracellular Ca ++ increase, will be stimulated to the production of collagen; clinically this is translated as hyper proliferation of the gums (11).…”

Gingivitis in Children and Adolescents

“…Patients on these medications develop varying degrees of gingival overgrowth (Trackman & Kantaki, 2004;Cury et al, 2009). Gingival enlargement is the most significant oral finding (Robbins, 2009) and can occour in up to 50% of patients taking Phenytoin (Thomason et al, 1992).…”