Proteins of the periodontium. Biochemical studies on the collagen and noncollagenous proteins of human gingivae

Determining the time of death by morphological and immunohistochemical evaluation of collagen fibers in postmortem gingival tissues

The estimation of the post mortem interval (PMI) is still one of the most challenging variables to determine and the different approaches currently used in its estimation generally yield to large post mortem windows. In the present study we combined morphological and immunohistochemical analysis in order to reach a more detailed knowledge on tissue organization and degradation after death. Ultrastructural cellular changes and the extracellular matrix of gingival tissues, collected at different post mortem intervals, were observed by a Transmission Electron Microscopy (TEM), in combination with the immunohistochemical detection of extracellular matrix proteins (i.e. collagen type I and collagen type III) as potential post mortem biochemical markers. The final goal was to find a correlation between morphological modifications, biomarkers expression and the time of death. Samples of gingival tissues obtained from 10 cadavers at different post mortem intervals (short post mortem interval, 1-3 days; mid post mortem interval, 4-6 days; long post mortem interval, 7-9 days) were processed for light microscopy and TEM and they were also immunostained with anti-collagen type I and type III antibodies. Results showed gradual degradation of extracellular matrix in the suboral connective tissue in relation to the different time of death. Moreover PMI was related to an increase of nuclear chromatin condensation and cytoplasmic vacuolization both in epithelial and connective tissues. In conclusion, in addition to traditional forensic approaches to estimate PMI, the combined analyses of cellular morphology, ultrastructure and immunohistochemical expression of collagen proteins allow to better infer the PMI.

Effect of Inflammation on the of Collagen Types, I, III, IV, and V and Type I Trimer and Fibronectin in Human Gingivae

The effect of inflammation on the distribution of collagen types I, III, IV, and V and type I trimer and fibronectin in human gingivae was studied after staining them with antibodies to these proteins, Gingival tissues were obtained after periodontal surgery and incubated with antibodies, and staining was visualized by indirect immunofluorescence using FITC- or rhodamine-conjugated second antibodies. The results showed that antibody to type I collagen stained normal gingival connective tissue uniformly and revealed the presence of thick fiber bundles, The staining was sparse at areas of inflammation and leukocytic infiltration. Anti-type-III antibody revealed a fine fibrillar netWork in the normal gingivae, especially near the epithelium; the type III was also lost at sites of inflammation. Type V collagen antibody also stained the gingival connective tissue intensely but, unlike the types I and III staining, it was retained in inflamed areas. Normal gingivae were not stained by the type I trimer antibody; however, staining occurred at inflamed sites. Both normal and inflamed tissues were stained by type IV collagen antibody. and the staining was restricted to basement membrane structures, The normal and inflamed gingivae contained a thick fiber network which bound unti-fibronectin antibody. We conclude that the various ginglvai collagen fibers are made up of collagen types I, III, and V, that the types I and III collagens are preferentially lost during inflammation, and that type I trimer appears at Inflamed sites.

Increased Accumulation of Sulfated Glycosaminoglycans in Cultures of Human Fibroblasts from Phenytoin-induced Gingival Overgrowth

Long-term ingestion of phenytoin elicits gingival overgrowth. We investigated sulfated glycosaminoglycan (GAG) metabolism by human gingival fibroblasts from normal gingivae and from phenytoin-enlarged gingivae. Incorporation, utilization, and subsequent loss of 35SO4= was measured in pulse-chase experiments. Fibroblasts from overgrown gingivae demonstrated increased accumulation of sulfated glycosaminoglycans. The increase was due to elevated synthesis and not to decreased degradation.

Immunohistochemical Localization of Epithelial Mesenchymal Transition Markers in Cyclosporine A Induced Gingival Overgrowth

INTRODUCTION

Cyclosporine, an immunosuppressive agent used in the management of renal transplant patients is known to produce Drug Induced Gingival Overgrowth (DIGO) as a side effect. Several mechanisms have been elucidated to understand the pathogenesis of DIGO. Recently, epithelial mesenchymal transition has been proposed as a mechanism underlying fibrosis of various organs.

AIM

The aim of the study was to investigate if Epithelial Mesenchymal Transition (EMT) operates in Cyclosporine induced gingival overgrowth.

MATERIALS AND METHODS

The study involved obtaining gingival tissue samples from healthy individuals (n=17) and subjects who exhibited cyclosporine induced gingival overgrowth (n=18). Presence and distribution of E-Cadherin, S100 A4 and alpha smooth muscle actin (α-SMA) was assessed using immunohistochemistry and cell types involved in their expression were determined. The number of α- SMA positive fibroblasts were counted in the samples.

RESULTS

In control group, there was no loss of E-Cadherin and a pronounced staining was seen in the all layers of the epithelium in all the samples analysed (100%). S100 A4 staining was noted in langerhans cells, fibroblasts, endothelial cells and endothelial lined blood capillaries in Connective Tissue (CT) of all the samples (100%) while α - SMA staining was seen only on the endothelial lined blood capillaries in all the samples (100%). However in DIGO, there was positive staining of E-Cadherin only in the basal and suprabasal layers of the epithelium in all the samples (100%). Moreover there was focal loss of E-Cadherin in the epithelium in eight out of 18 samples (44%). A break in the continuity of the basement membrane was noted in three out of 18 samples (16%) on H & E staining.

CONCLUSION

Based on the analysis of differential staining of the markers, it can be concluded that EMT could be one of the mechanistic pathways underlying the pathogenesis of DIGO.

Gingival tissue proteoglycan and chondroitin-4-sulphate levels in cyclosporin A-induced gingival overgrowth and the effects of initial periodontal treatment

OBJECTIVES

Cyclosporin A (CsA) is a potent immunosuppressive drug used in organ transplant patients to prevent graft rejection. CsA-induced gingival overgrowth is one of the side effects of this drug and its pathogenesis is still unclear. The present study was planned to comparatively analyse total proteoglycan (PG) and chondroitin-4-sulphate (C4S) levels in CsA-induced overgrown gingival tissue samples obtained before and after initial periodontal treatment and to compare these findings with the situation in healthy gingiva.

MATERIAL AND METHODS

Gingival tissue samples were obtained from nine patients with CsA-induced gingival overgrowth before and 4 weeks after initial periodontal treatment including oral hygiene instruction and scaling and also from 10 healthy control subjects. Total PG and C4S levels were determined by biochemical techniques. PG levels were analysed using modified Bitter and Muir method. C4S assay was carried out using chondroitin sulphate lyase AC and chondroitin-6 sulphate sulphohydrolase enzymes. The results were tested statistically using non-parametric tests.

RESULTS

All clinical measurements in the CsA-induced gingival overgrowth group demonstrated significant reductions 4 weeks after initial periodontal treatment (p<0.05). There was no significant difference between the levels of baseline total PG in CsA-induced gingival overgrowth and healthy control groups (p>0.05). The gingival tissue levels of PG in CsA-induced gingival overgrowth group decreased significantly 4 weeks after treatment (p=0.043). Gingival tissue C4S levels in the overgrowth group were significantly higher than the healthy control group at baseline (p=0.000). C4S levels of the overgrowth group were significantly reduced after treatment (p=0.033), but these levels were still significantly higher than the healthy control group (p=0.000).

CONCLUSION

The observed prominent increase in gingival tissue C4S levels may be interpreted as a sign of an increase in C4S synthesis in CsA-induced gingival overgrowth. Furthermore, remission of clinical inflammation by means of initial periodontal treatment had a positive effect on tissue levels of these extracellular matrix molecules.

Polyclonal B cell activators and in vitro induction of auto-antibody reactive with collagen

Cells producing autoantibodies are known to be present in chronically inflamed periodontal tissues. In sites of chronic inflammation, polyclonal B cell activators (PBA) are known to exhibit adjuvant activity when combined with foreign antigens. These results prompted an examination of PBA in eliciting an antibody response to an autoantigen (i.e. collagen type I). Rat lymphocytes were stimulated with rat collagen (type I), microbial PBA (LPS) or the combination of LPS plus rat collagen in vitro. Anti-collagen antibody-forming cells (AFC) were enumerated using an ELISPOT assay. Collagen or LPS alone elicited few anti-collagen AFC but the addition of LPS to collagen resulted in a substantial adjuvant effect and yielded maximal responses to collagen. Comparisons of anti-collagen AFC from short-term immunized (2-6 wk after booster), non-immunized and long-term immunized (3-4 months after booster) animals were performed. It revealed that cells from recently immunized rats were significantly easier to activate than the other 2 groups. The adjuvant effect of microbial PBA may be important in anti-collagen antibody production and thus the localization of PBA in periodontal pockets may explain why anti-collagen AFC are restricted to the chronically inflamed periodontal tissues.

The pathogenesis of drug-induced gingival overgrowth

Gingival overgrowth is a well-documented unwanted effect, associated with phenytoin, cyclosporin, and the calcium channel blockers. The pathogenesis of drug-induced gingival overgrowth is uncertain, and there appears to be no unifying hypothesis that links together the 3 commonly implicated drugs. In this review, we consider a multifactorial model which expands on the interaction between drug and/or metabolite, with the gingival fibroblasts. Factors which impact upon this model include age, genetic predisposition, pharmacokinetic variables, plaque-induced inflammatory and immunological changes and activation of growth factors. Of these, genetic factors which give rise to fibroblast heterogeneity, gingival inflammation, and pharmacokinetic variables appear to be significant in the expression of gingival overgrowth. A more thorough understanding of the pathogenesis of this unwanted effect will hopefully elucidate appropriate mechanisms for its control.

Cloning, characterization, and antigen specificity of T-lymphocyte subsets extracted from gingival tissue of chronic adult periodontitis patients

Chronic periodontitis is characterized by dense infiltrations of B and T lymphocytes within the gingival connective tissue. Distinct anaerobic gram-negative bacteria as well as autoimmunity to collagen have been reported to play a role in the etiology and the pathogenesis of this disease. Here we describe the cloning and characterization of CD4+ and CD8+ T lymphocytes isolated from inflamed gingival tissue obtained from four patients with chronic periodontitis. Clones were raised with phytohemagglutinin and interleukin-2 and tested for proliferation in response to whole-cell antigens of Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemcomitans, human collagen type I, and two bacterial heat shock proteins. CD4+ T-cell clones reactive with collagen type I were obtained from all four patients. Eighty percent of these clones had phenotypes resembling the mouse type 2 T helper (Th) phenotype, i.e., they produced high levels of interleukin-4 and low levels of gamma interferon. No collagen-type-I-reactive CD8+ clones were obtained. Bacterial-antigen-reactive CD4+ and/or CD8+ T-cell clones were also obtained from each patient, and the majority of the clones showed a Th0-like cytokine pattern and produced equal amounts of interleukin-4 and gamma interferon. Although most clones were reactive with P. intermedia, it seems that the immune response is not strictly directed against this particular microorganism, as clones reactive with one of the other bacteria were also obtained from two patients. We propose that collagen-specific CD4+ Th2-like T cells contribute to the chronicity of periodontitis but that their modes of activation might be controlled by Th0-like T cells specific for periodontitis-associated bacteria.

Altered expression of extracellular matrix proteins and integrins in oral lichen planus (OLP)

The immunohistochemical distribution of collagens type I, III, IV, V, VI, of undulin and tenascin, and of integrins alpha 2, alpha 3, alpha 4, alpha 5, alpha 6 and beta 4, was studied in 14 biopsies of oral lichen planus (OLP), 5 biopsies of orthokeratinized gingiva and 4 biopsies of oral fibrous hyperplasia. The localization of extracellular matrix proteins showed altered expression in OLP when compared to normal oral mucosa, with two principal patterns corresponding to the reticular or atrophic type. Whereas in the reticular type a focal loss of immunoreactivity for collagen types I, III, V, VI and undulin was noted in areas with a cellular infiltrate, in the atrophic variant almost complete loss of immunoreactivity of the subepithelial extracellular matrix was found. There was no clear correlation between the distribution of extracellular matrix proteins and their integrin receptors. The present findings suggest that the autoimmune reaction in OLP might not be primarily targeted to oral keratinocytes but to an unknown antigen in the connective tissue stroma. The changes in the subepithelial extracellular matrix associated with the inflammatory reaction might, especially in the atrophic variant, impair the cross-talk between epithelium and mesenchyme and favour both the loss of barrier function and the development of erosions in the clinical course of the disease.

Immunohistochemical distribution of collagens type I, III, IV and VI, of undulin and of tenascin in oral fibrous hyperplasia

The distribution of collagens type I, IV and VI, of procollagen type III, of undulin and of tenascin was studied in 10 lesions which were clinically and histologically diagnosed as localized oral fibrous hyperplasias. The immunohistochemical distribution of these proteins was similar to that observed for normal oral mucosa. Undulin showed a pattern of parallel fibers throughout. Collagen type VI was pronounced in the subepithelial connective tissue, whereas the collagen fiber bundles were equally reactive for collagens type I and III. Tenascin was observed close to the subepithelial basement membrane and in proximity to collagen fiber bundles in the upper connective tissue. The present findings indicate that oral fibrous hyperplasias that are probably caused by inflammation or chronic irritation show the differentiated and ordered pattern of extracellular matrix proteins characteristic of normal oral mucosa.

Periodontal condition of epileptic adults treated long-term with phenytoin or carbamazepine

The periodontal condition of 40 adult epileptic subjects (mean age 51 years) receiving long-term therapy (mean 18 years) with phenytoin (PHT) or carbamazepine (CBZ) was studied. The subjects completed a questionnaire and underwent clinical and radiologic examination. Patients receiving PHT exhibited the same level of alveolar bone loss as those receiving CBZ. Patients receiving PHT exhibited more units with gingival overgrowth, reflected by the significantly higher number of gingival units with increased probing depth (p < 0.05). The results indicate that long-term PHT does not result in increased risk for alveolar bone loss as compared with CBZ.

Extracellular matrix analysis of nifedipine-induced gingival overgrowth: immunohistochemical distribution of different collagen types as well as the glycoprotein fibronectin

The purpose of this study was to demonstrate the localization of collagen types I, III, IV, V, VI and VII as well as the glycoprotein fibronectin in nifedipine-induced gingival overgrowth. The slices, after the use of indirect immunofluorescence (incubation with antibodies against these extracellular matrix components), showed a diffuse distribution with the anti-types I and III in the stroma and fluorescent staining of the basement membranes of the epithelium, blood vessels and nerves with collagen type IV antibodies. The increased number of vessels was localized near the surface of the lesion. Collagen type V - seen as a filamentous - and collagen type VI - as microfibrillar - components were also localized in the tissue, showing completely different patterns of distribution. Collagen type V appeared "crater"-like and type VI displayed a "honeycomb"-shaped structural model. The blood vessels were not stained but the area around their walls demonstrated an intense fluorescence with these antibodies. Collagen type VII showed a characteristic linear staining near to the epithelial basement membrane. In contrast to this, fibronectin localized with a varied intensity in the different areas of the tissues and presented a "cloud"-like structure. This shows differences between the matrix components in nifedipine-induced hyperplasia and confirms the heterogeneity of the matrix in health and in gingival alterations.

Distribution of fibronectin in healthy, inflamed and drug-induced gingival hyperplasia

The distribution of fibronectin (FN) in the healthy, inflamed and hyperplastic human gingiva was investigated by indirect immunofluorescence. FN appeared as a fibrillar structure in the lamina propria of the healthy gingivae. In the inflamed specimens, FN demonstrated parallel fibres, especially in the coronal areas of the tissue. In the phenytoin gingival overgrowth, tissue FN was observed as thin fibres with variable length. The thin fibres gave the appearance of penetrating the basement membrane of the epithelium. Cyclosporin A gingival enlargement could be differentiated by phenytoin lesions because of the higher length and the parallel distribution of the FN. Finally, FN was observed in the nifedipine gingival overgrowth, where a microfibrillar delicate network gave the appearance of a "cloud"-pattern of distribution. In all of the specimens, blood vessels and nerves could not be stained. These findings show that FN distribution could differentiate the structure of the gingival lesions.

Immunohistochemical localization of collagenous components in healthy periodontal tissues of the rat and marmoset (Callithrix jacchus). I. Distribution of collagen types I and III

The distribution of collagen types I and III was demonstrated in healthy periodontal tissues of the rat and marmoset using immunofluorescent localization after decalcification of the maxillae and mandiblae in 0.2 N HCl. An intense fluorescence in the alveolar bone and cementum matrix, as well as in the soft periodontal tissue, was demonstrated with anti-collagen type I antibodies. In the gingival connective tissue and in the periodontal ligament thick fibers of collagen type I could be observed. The fluorescent reaction in the rat periodontal ligament was not strong in comparison to the marmoset periodontal ligament. Sharpey's fibers, inserting into the cementum and alveolar bone, were also stained. On the other hand, collagen type III could not be demonstrated in the hard periodontal tissues, but could be in the bone marrow stroma and the incremental lines as well as around the Sharpey's fibers of the cementum, in accordance to previous studies. In the gingival connective tissue a strong staining was evident, especially near the basement membrane. The periodontal ligament showed an intense fluorescence that was, in some areas, continuous with Sharpey's fibers inserting into the cementum. The distribution of collagen types I and III was demonstrated with immunohistochemical techniques in the rat and marmoset periodontium. These results provide necessary information on healthy tissues that will be required for future studies on the effects of pathological, reparative and regenerative processes.

Autoimmunity to collagen in adult periodontal disease: immunoglobulin classes in sera and tissue

The immunoglobulin class distribution of antibody to human collagen type I has been examined in sera and gingival extracts from patients with adult chronic periodontitis. Tissue extracts were made either by simple washing or ultrasonication. With either method, IgG and IgA antibodies to collagen were present in higher concentration in tissue extracts than in autologous serum when adjustment was made for dilution differences. No significant differences were found for IgM antibodies. Antibodies to human collagen type I are usually "natural antibodies" of the IgM class and, therefore, our findings suggest a class switch to IgG in inflamed gingivae, presumably due to prolonged antigenic stimulation.

Immunoelectron microscopy shows an atypical pattern and a quantitative shift of collagens type I, III and VI in oral Kaposi's sarcoma of AIDS

The localization of collagen types I, III and VI in normal human alveolar and palatal mucosa and in oral Kaposi's sarcoma (KS) was studied by light microscopy and cryo-immunoelectron microscopy. Normal oral mucosa revealed two different types of organization. The upper connective tissue stroma contained a loose reticular network mainly composed of collagen types III and VI, while collagen type I immunostaining predominated in the deeper stroma. Ultrastructurally, in the KS tumour stroma, a loose pattern of individual thin collagen fibrils was noted. These often fanned out at their ends showing a filamentous substructure. The fibrils consisted predominantly of collagen type I similar to individual fibrils of normal oral mucosa. However, there was a marked loss of thick fibre bundles of collagen types I and III in KS compared with normal oral mucosa, whereas collagen type VI was markedly increased and found preferentially in clusters and strands around cross-striated fibrils that often spanned the distance between single collagen fibres. The abundance of collagen type VI in a pattern similar to early stages of wound healing suggests that the KS stroma resembles an early organizational stage of the interstitial and vascular extracellular matrix subject to a high rate of collagen turnover. This character of the KS stroma appears to result from a continuous auto-and paracrine stimulation of cell growth and collagen synthesis and provides an excellent model to study the structural arrangement of collagen type VI in relation to the fibrillar collagen types I and III.

Distribution of collagens type V and VI in the normal human alveolar mucosa: an immunoelectronmicroscopic study using ultrathin frozen sections

The ultrastructural localization of collagens type V and VI in normal human gingival mucosa was investigated by immunoelectron microscopy. Twenty biopsies were fixed in dimethylsuberimidate and shock-frozen in slush nitrogen. Collagen type V was mainly located to meshworks of uniform nonstriated microfibrils of 12 to 20 nm width, which preferentially appeared in larger spaces between cross-striated major collagen fibrils. Occasionally single microfibrils of collagen type V fanned out from the ends of major collagen fibrils, which may indicate a role as a core fibril. Collagen type V was not found in the subepithelial basement membrane and the immediately adjacent stroma. Collagen type VI was detected in a loose reticular network of unbanded microfilaments that were morphologically distinguishable by knoblike protrusions every 100-110 nm. These microfilaments were found in the vicinity, but not as an intrinsic component, of the subepithelial basement membrane. Single filaments of collagen type VI filaments appeared to form bridges between neighboring cross-striated major collagen fibrils, suggesting an interconnecting role for this collagen type. The method presented appears to be excellently suited to study the normal and pathological supramolecular organization of the oral extracellular matrix.

On the mechanism of drug-induced gingival hyperplasia

Proposed mechanisms of the side effect of drug-induced gingival hyperplasia are reviewed. Hypotheses with regard to inflammation from bacterial plaque, increased sulfated glycosaminoglycans, immunoglobulins, gingival fibroblast phenotype population differences, epithelial growth factor, pharmacokinetics and tissuebinding, collagenase activation, disruption of fibroblast cellular sodium/calcium flux, folic acid and a combination hypothesis are evaluated.

Effect of phenytoin medication on the metabolism of epidermal growth factor receptor in cultured gingival fibroblasts

Human gingival fibroblasts derived from 2 patients before and 9 months after the start of phenytoin (PHT) therapy were studied with respect to the effect of epidermal growth factor (EGF) on the incorporation of 3H-thymidine into DNA, binding of EGF to its cell-surface receptor, internalization of EGF-receptor-ligand complexes and, finally, with respect to EGF receptor mRNA levels. In fibroblasts derived from the patient who developed gingival overgrowth during the PHT medication (responder) as well as in the fibroblasts derived from the patient where gingival overgrowth did not develop (non-responder), the affinity of the EGF receptor for EGF was not significantly changed. In the non-responder patient the internalization of EGF receptor ligand was decreased, whereas it was increased in the fibroblasts derived from the responder patient after PHT therapy. The steady-state level of EGF-r mRNA increased significantly (p less than 0.001) in the cultured fibroblasts derived from the non-responder but decreased (p less than 0.05) in the responder patient following PHT therapy. Ligand affinity cross-linking studies revealed one major component of EGF receptor with a molecular weight of 170 KDa in fibroblasts from the non-responder as well as from the responder. The study indicates that PHT medication results in a down-regulation of EGF receptor metabolism in fibroblasts derived from a responder patient, whereas in the non-responder patient EGF receptor metabolism is up-regulated.

Immunohistochemical study of neuronal markers in human gingiva with phenytoin-induced overgrowth

The immunohistochemical occurrence of several different neuronal markers has been investigated in human gingiva with phenytoin-induced overgrowth. The material was compared to gingival material taken following surgical orthodontic treatment. Gingiva obtained from the phenytoin-treated groups seemed to have a reduced number of neurofilament (NF) immunoreactive nerve fibers in the propria compared to control material. In both phenytoin as well as control gingiva sparsely distributed, thin, calcitonin gene-related peptide (CGRP) and substance P (SP) immunoreactive fibers were found in the propria. No obvious differences between the two groups could be observed for CGRP and SP. Immunoreactive cells for somatostatin (SOM) with a dendritic cell shape were found in the propria in both groups, sometimes in densely packed clusters. A tendency for increase of SOM-immunoreactive cells in the phenytoin-treated gingiva was observed. A few gamma-melanocyte stimulating hormone (gamma-MSH)-immunoreactive cells with a round appearance were found in control as well as phenytoin-affected gingiva. In one instance, however, a heavy gamma-MSH-immunoreactive cell infiltration was seen in the phenytoin sample. No immunoreactivity in either the phenytoin-treated group or in the control group was seen for proctolin or galanin. The results indicated that gingiva with phenytoin-induced overgrowth has a reduced innervation density revealed with NF immunohistochemistry.

Isolation of noncollagenous proteins from gingival connective tissue

Noncollagenous proteins form an integral part of gingiva and other connective tissues. We have performed studies aimed at purification and partial characterization of the gingival noncollagenous proteins. Healthy gingival tissues from mongrel dogs were extracted in neutral buffers, acetic acid, and 6 mol/L urea. Immunoblots using anti-keratin antibodies and CNBr peptide patterns revealed that the majority of the proteins present in these extracts were keratins. To exclude keratins, gingival connective tissue was separated from the epithelium and then extracted. Acid extracts of the connective tissue contained very little protein, whereas urea extracts contained collagen and other noncollagenous proteins. The noncollagenous proteins present in the urea extract were partially purified by DEAE-cellulose chromatography and separated by affinity chromatography through a Sepharose 4B-type I collagen column. At least eight proteins, which ranged in molecular size from 15 to 75 kilodaltons, were obtained by this procedure. We conclude that keratins are major components of whole gingiva extracts and that epithelium must first be removed in order for connective tissue proteins to be obtained. The gingival connective tissue appears to contain several collagen-binding proteins, and these proteins may play an important role in the structure and function of the gingival matrix.

Synthesis of sulfated glycosaminoglycans by human gingival fibroblasts from phenytoin-induced gingival overgrowth in vitro

The in vitro synthesis of sulfated glycosaminoglycans (GAGs) was studied in gingival fibroblasts from two patients exhibiting phenytoin(PHT)-induced gingival overgrowth, i.e. pseudopockets, which required surgical excision, from one patient on PHT medication not exhibiting pseudopockets and from two normal controls. The results showed that the newly synthesized GAGs were distributed to the culture medium, to a pericellular pool and to the cell fraction. Gingival fibroblasts from the PHT-induced gingival overgrowth showed a significantly increased incorporation of 35SO4(2-) into GAGs compared to the other strains, and this increase was mainly confined to the dermatan sulfate fraction. These results are in accordance with our previous biochemical studies where increased amounts of GAGs were found in gingival biopsies from the PHT-induced lesion.

Drug-induced gingival hyperplasia: phenytoin, cyclosporine, and nifedipine

This article has summarized observations and results of controlled laboratory and clinical studies of drug-induced gingival hyperplasia associated with phenytoin, cyclosporine, and nifedipine use. Furthermore, information regarding the pharmacologic aspects of these medications is presented. More information is needed for a greater understanding of drug-induced gingival hyperplasia. It appears that the primary preventive measure is to maintain a high standard of oral hygiene and the elimination of gingival irritation. As stated by Tyldesley and Rotter, because the structures of the three drugs are different, the gingival changes may result from a metabolic by-product rather than the drugs themselves. Similarly acting metabolites of all the drugs may be involved. Further laboratory investigations and controlled clinical trials are needed for more understanding of this phenomenon.

Antibody to collagen type I in periodontal disease

Serum antibody levels to human collagen Type I were measured in 97 patients with periodontal disease (Russell Periodontal Index 1.0-7.0) and 57 control subjects (Periodontal Index less than 1.0) using an enzyme-linked immunosorbent assay, which had been standardized with antisera prepared against human collagen Type I in rabbits. Absorption studies were used to confirm the specificity of antibodies to human Type I collagen. Levels of antibody to Type I collagen detected in patients were higher (P less than 0.001) than in the control subjects.

Glycylprolyl dipeptidylaminopeptidase from Bacteroides gingivalis

Dipeptidyl aminopeptidase activity was found in the culture medium of Bacteroides gingivalis 381. The enzyme, hydrolyzing glycylprolyl-4-methylcoumaryl-7-amide, was purified 750-fold from culture medium by ammonium sulfate precipitation, Sephadex G-200 gel filtration, and DEAE Bio Gel A column chromatography. The molecular weight, determined by gel filtration, was approximately 160,000. The isoelectric point of the enzyme, estimated by isoelectric focusing using polyacrylamide disk gel electrophoresis, was about pH 6.2. The optimum pH of the enzyme was about 8.0, and the Km value was 0.05 mM. The enzyme activity was strongly inhibited by phenylmethylsulfonylfluoride and diisopropylfluorophosphate. The purified enzyme specifically cleaved glycylprolyl dipeptide from partially digested type I collagen.

Characterisation of collagen from normal and scoliotic human spinal ligament

Acid-soluble and pepsin-soluble collagens have been isolated from spinal ligaments of normal and scoliotic individuals. Polyacrylamide gel electrophoresis of native and cyanogen bromide-treated collagens, and amino acid analysis, showed that the ligament collagen is almost all of the Type I variety with only trace amounts of Type III present. There was no evidence for abnormal ratios of collagen alpha-chains, or underhydroxylation of proline and lysine in the scoliotic ligament. These results indicate that collagen biochemistry is normal with respect to type, post-translational modification and cross-linking in spinal ligaments of patients with idiopathic scoliosis. Elastin and proteoglycan were only minor components of the ligaments. The nature of the non-collagenous part of the ligament is unknown, although it contains some proteins with a hydrophobic nature.

Quantitative histopathologic assessment of developing phenytoin-induced gingival overgrowth in the cat

Phenytoin (Dilantin) induces gingival overgrowth characterized by an accumulation of connective tissue The cell-to-matrix ratio in the mature lesion is normal, yet there must be more fibroblasts per oral cavity if there is excessive tissue mass. Using a mongrel cat model system, we studied the early, developing phenytoin-induced lesion by quantitating fibroblasts per unit of tissue in papilla biopsies collected over a 3-month period of daily drug administration. At 6 and 8 weeks, the number of fibroblasts per unit of tissue increased dramatically. By 3 months, as the lesions matured, the fibroblast-to-matrix ratio returned to normal. We suggest that the drug interacts with resident gingival fibroblasts, causes them to proliferate and thus induces a true, but transient, hypercellularity. Cell division then appears to slow or cease, and rapid production of connective tissue matrix ensues, returning the cell-to-matrix ratio to normal.

Ultrastructural quantitation of connective tissue changes in phenytoin-induced gingival overgrowth in the ferret

The gingival overgrowth obtained after maintaining ferrets on PHT appeared to be due entirely to the effect of the drug, for inflammation induced by banding had no influence on the action of PHT in eliciting the overgrowth. The significant change observed was an increase in relative volume of interstitial material (ground substance) in response to PHT. Although there was no appreciable alteration in numbers of cells present in the lesion, PHT had a significant effect on the ultrastructure of fibroblasts. These cells showed a decrease in the relative volume of phagosomes, although organelles concerned with synthesis (the rough endoplasmic reticulum and Golgi zones) were not affected. This suggests that the relative increase in ground substance may reflect decreased breakdown of extracellular material within fibroblasts, while synthetic activity is maintained at a constant level. As a consequence, there is an increase in connective tissue volume--an increase which is manifested as an overgrowth.

Increased collagen synthesis by gingival fibroblasts derived from a Papillon-Lefévre patient

Both skin and gingival fibroblasts in the Papillon-Lefévre patient synthesized Type I and Type III collagen in a ratio very similar to fibroblasts of control cells. The only abnormality appeared to be elevated levels of collagen and protein synthesis by gingival cells derived from the Papillon-Lefévre patient.

Isolation and partial characterization of bovine gingival AB collagen

Limited proteolysis with pepsin solubilized 25% of the insoluble gingival matrix as mainly soluble collagenous material. Fractional salt precipitation at neutral pH resulted in the separation of types III and I at 1.8 and 2.6 M NaCl, respectively. In addition, a collagenous fraction accounting for 2% of the solubilized collagen and precipitating at 4.5 M NaCl was shown to be identical with type V collagen. Isolation and partial characterization of the constituent-alpha-chains of the 4.5 M PPT by gel filtration, ion exchange and hydroxylapatite chromatography as well as disc electrophoresis showed that gingival type V collagen contains alpha A and alpha B chains in a ratio alpha B/alpha A of 1.73-1.8. Electron microscopic examination of ATP-precipitates showed that this collagen type gave only one kind of SLS aggregates with asymmetric band pattern characteristically different from that of type I collagen. The data provide evidence that gingival AB collagen is a heteropolymer in which the alpha A and alpha B chains are assembled in the same macromolecule in a 1:2 ratio.

Characterization of collagens of diseased human gingiva

In the gingiva and other connective tissues, alteration in the collagens is primarily responsible for their functional impairment during disease. To study the collagen alterations, we extracted diseased human gingival tissue with neutral and acidic solvents and then with pepsin. The pepsin extract was separated into proteins soluble in 2.5 and 1.5 M NaCl and proteins insoluble in 1.5 M NaCl. By the criteria of solubility behavior in NaCl solutions, elution from (carboxymethyl)cellulose (CM-cellulose) columns, sodium dodecyl sulfate (NaDodSO4)-polyacrylamide gel electrophoresis, CNBr peptide pattern, and amino acid composition, the collagens of acidic and neutral solvent extracts and 1.5 M soluble fraction of pepsin extract were characterized as type I collagen and the 1.5 M NaCl insoluble collagen as type III. The 2.5 M NaCl fraction contained alpha 2, A, and B chains. The alpha 1 chains resembled alpha 1[I] in amino acid composition, and, since alpha 2 chains were lacking, it appeared that these chains derived from type I trimer collagen. The A and B chains were purified from the 2.5 M NaCl fractions by salting out at acidic pH. The final (A plus B) chain fraction was resolved into two major and one minor protein peaks by phosphocellulose chromatography. The major peaks were characterized as A and B chains on the basis of amino acid composition and CNBr peptide patterns. The minor peak had electrophoretic mobility slightly less than B chains, and the amino acid composition was different. Analysis of the proportion of different collagen types extracted indicated that type III collagen, which is the second major fraction in other connective tissues, is only a minor constituent in the gingiva. More interestingly, A and B chains accounted for a greater proportion than type III. Unlike the fibroblast cultures, the type I trimer formed only a small proportion of collagens of diseased gingival tissue.

Collagenase in the human periodontal ligament

Collagenase activity was demonstrated by direct incubation to be present in human periodontal ligament. This activity was found in only one of two populations of ligament, i.e., those ligaments taken from teeth in which their attachment site was at least 2.5 mm apical to the cementoenamel junction. The collagenase was demonstrated to be of host origin because it degraded collagen into 3/4 and 1/4 alpha chain fragments characteristic of mammalian collagenases. The enzyme was shown to be inhibited in the presence of EDTA and to have a pH optimum of 7.5.

Gingival matrix collagen in chronic periodontitis

The isolation and characterization of cyanogen bromide peptides derived from the human gingival collagen of patients with chronic periodontitis revealed the presence of both Type I and Type III collagens in this tissue. The amount of TYPE III collagen, however, was found to be lower than that in normal gingival tissue. In addition, a non-collagenous protein fraction, accounting for approximately 20% of the insoluble matrix, was relatively rich in acidic, hydrophobic, and hydroxy-containing amino acids. Amino acid analysis, likewise, revealed qualitative and quantitative differences between the normal and diseased tissues.

Specific immunohistochemical localization of type I collagen in porcine periodontal tissues using the peroxidase-labelled antibody technique

Antibody against Type I collagen was raised in rabbits and purified by immunoadsorption on Sepharose-conjugated Types I and III collagen. The cross-reactivity of purified antibody to Type III collagen was found to be less than 0.5% by passive haemagglutination and less than 1.5% by radioimmunoassay. When paraffin sections of fixed and decalcified pig molars were incubated with purified antibody to Type I collagen, varying degrees of staining were observed in the ligament, gingiva, bone and cementum. The periodontal ligament adjacent to bone was more widely stained than that adjacent to cementum in some regions, whereas in others, no difference in staining could be discerned between the two halves of the ligament. The lamina propria of gingiva was stained, and this appeared to be most intense in the vicinity of the overlying epithelium. The fibrous component in the endosteal spaces, the dentine and the extracellular coronal elements in the pulp were generally stained. The impression obtained from the staining pattern is that Type I collagen is not restricted to particular regions of the periodontal ligament or the lamina propria of the gingiva.

Confirmation that neither phenotype nor hydroxylation of collagen is altered in overgrown gingiva from diphenylhydantoin-treated patients

Collagens, solubilized by pepsin-digestion of diphenylhydantoin-induced overgrown gingiva, appeared similar to collagens solubilized from inflamed gingiva with regard to: ratio of type I to type III collagen, ratio of alpha1 to alpha2 of type I collagen, and degree of hydroxylation of type I collagen.

Study of the noncollagenous components of the periodontium

Periodontal ligament and gingivae of bovine and porcine periodontium were analyzed for relative amounts of carbohydrates, collagen, and acid mucopolysaccharides. The sugar content was 3.6% and 3.4% of dry weight in bovine and porcine periodontal ligament, respectively. The values were lower in the gingivae being 2.34% and 2.30%, respectively. Approximately 50% of hexosamine in gingivae was present in acid mucopolysacchrides as compared to 36% in periodontal ligament. Relative to collagen there was a considerable amount of non-collagenous glycoproteins present in the periodontium as judged by carbohydrate content of the tissue.

Noncollagenous proteins of a rat dentin matrix possessing bone morphogenetic activity

An insoluble preparation of rat dentin matrix was shown to possess bone morphogenetic protein (BMP) activity, i.e. the capacity to induce the formation of catilage and bone when implanted intramuscularly. Since BMP activity was previously attributed to noncollagenous proteins (NCP) of bone and dentin, the nature of NCP of the rat dentin was examined. After treatment of the matrix with purified bacterial collagenase, three NCP were solubilized concomitantly with digestion of the dentin collagen to smaller peptides. The three proteins were separated by anion-exchange chromatography on DEAE-cellulose. Two of the NCP were rich in asparate, glutamate, glycine, serine, and alanine, and thus displayed compositions similar to acidic proteins of other connective tissues. The third NCP was shown by amino acid composition to be the aspartate, serine-rich phosphoprotein, which occurs mostly in a soluble form in rat dentin. This observation supports the view that a portion of dentin phosphotprotein is firmly bound.

Biochemical characteristics and biological significance of the genetically-distinct collagens

In recent years it has become evident that genetic polymorphism is dramatically expressed in the structural protein, collagen. Current information on the biochemical properties, biosynthesis, and tissue distribution of Type I, II, and III collagens is summarized with special reference to possible unique functional roles fulfilled by each of these collagens.