The differentiation profile of the epithelium of the human lip

Reconstruction of functional human lips utilizing a prelaminated flap

Lips form a structure that are difficult to reconstruct after a traumatic avulsion injury or cancer ablative surgery secondary to loss of volumetric muscle mass. Traditional tissue engineering approaches of in vitro fabrication of mature tissue constructs can supply an alternative to the current surgical standard of care for functional lip reconstruction. We demonstrate a hybrid approach that combines the advantages of in situ muscle flap prefabrication with in vitro fabrication of an autogenous mucocutaneous construct as the laminate for prelamination to form a designer microvascular muscle free flap for lip reconstruction.

Human lip vermilion: Physiology and age-related changes

BACKGROUND

The human lip vermilion, also known as the red lip, is important to the quality of life and has long attracted the attention of cosmetic researchers. However, there is limited existing literature on the physiological characteristics and age-related alterations in the human vermilion.

OBJECTIVE

We aim to provide an overview of the physiological characteristics and age-related alterations in the human vermilion.

METHODS

This article is a result of previous research. We conducted a literature search using various academic databases such as Google Scholar, Web of Science, and PubMed. Our findings provided a comprehensive understanding of the physiological characteristics and age-related changes of the human lip vermilion.

RESULTS

The human lip vermilion has a unique structure and physiological characteristics, and during the aging process, a few changes may occur in the human lip vermilion.

CONCLUSION

Understanding the human lip vermilion's physiological characteristics and age-related changes can provide key information for the future innovation of lip vermilion care products. Further investigations are necessary to reach a consensus on the physiological characteristics and age-related alterations in the human vermilion.

Reflecting the human lip in vitro: Cleft lip skin and mucosa keratinocytes keep their identities

OBJECTIVES

Cell models have shown great promise as tools for research, potentially providing intriguing alternatives to animal models. However, the original tissue characteristics must be maintained in culture, a fact that is often assumed, but seldom assessed. We aimed to follow the retention of the original tissue identities of cleft lip-derived skin and mucosa keratinocytes in vitro.

METHODS

Cleft lip-derived keratinocytes were isolated from discarded tissue along the cleft margins during cheiloplasty. Cell identities were assessed by immunohistochemistry and quantitative real-time PCR for tissue-specific markers and compared with native lip tissue. Moreover, keratinocytes were regularly analyzed for the retention of the original tissue characteristics by the aforementioned methods as well as by differentiation assays.

RESULTS

The various anatomical zones of the human lip could be distinguished using a panel of differentiation and functional-based markers. Using these markers, retention of the original tissue identities could be followed and confirmed in the corresponding primary keratinocytes in culture.

CONCLUSIONS

Our findings promote patient-derived cells retaining their original identities as astonishing and clinically relevant in vitro tools. Such cells allow a better molecular understanding of various lip-associated pathologies as well as their modeling in vitro, including but not restricted to orofacial clefts.

Development of a lip vermilion epithelium reconstruction model using keratinocytes from skin and oral mucosa

Lip vermilion is unique and can be distinguished from the adjacent skin and oral mucosa. However, because of the lack of appropriate evaluation tools, skin and/or oral mucosa substitutes such as in vitro vermilion epithelial models have been used for lip product testing. We aimed to develop and characterize a lip vermilion epithelium reconstruction model (LVERM) using skin and oral keratinocytes. LVERM was manufactured by co-culturing primary skin and oral keratinocytes, using a device that allowed the separation of cell seeding, and created an intercalated cell-free zone, referred to as the vermilion part. After removing the device, LVERM construction was completed in 8 days, in a submerged condition. Subsequently, they were placed in an air-liquid interface for 7 days. To determine the epithelial characteristics of LVERM, keratin 2e (KRT2) and small proline-rich protein 3 (SPRR3) expression patterns were examined. The in vivo expression profiles of KRT2 and SPRR3 genes in vermilion were also examined. We found that a continuous multi-layered epithelium was generated in the LVERM that exhibited ortho- and para-keratinization in the skin and oral mucosa parts, respectively. Although an intermediate keratinization pattern was observed in the vermilion part, KRT2 and SPRR3 were co-expressed in the suprabasal layer, consistent with the expression pattern of a single vermilion epithelial model. Clustering analysis revealed that KRT2 and SPRR3 gene expression in vermilion was location-dependent within the sample. Therefore, LVERM can be used as an evaluation tool for lip products and has great importance in innovative approaches for cosmetic testing.

Beyond language: The unspoken sensory-motor representation of the tongue in non-primates, non-human and human primates

The English idiom "on the tip of my tongue" commonly acknowledges that something is known, but it cannot be immediately brought to mind. This phrase accurately describes sensorimotor functions of the tongue, which are fundamental for many tongue-related behaviors (e.g., speech), but often neglected by scientific research. Here, we review a wide range of studies conducted on non-primates, non-human and human primates with the aim of providing a comprehensive description of the cortical representation of the tongue's somatosensory inputs and motor outputs across different phylogenetic domains. First, we summarize how the properties of passive non-noxious mechanical stimuli are encoded in the putative somatosensory tongue area, which has a conserved location in the ventral portion of the somatosensory cortex across mammals. Second, we review how complex self-generated actions involving the tongue are represented in more anterior regions of the putative somato-motor tongue area. Finally, we describe multisensory response properties of the primate and non-primate tongue area by also defining how the cytoarchitecture of this area is affected by experience and deafferentation.

Comprehensive histological investigation of age-related changes in dermal extracellular matrix and muscle fibers in the upper lip vermilion

OBJECTIVE

Few histological studies have directly examined age-related changes within the lips, although non-invasive investigations of such changes are increasing. Therefore, this study aimed to provide histological and molecular data on age-dependent alterations in the vermilion.

METHODS

Upper vermilion specimens from 15 female Caucasian cadavers (age range, 27-78 years) were investigated histologically or immunohistochemically.

RESULTS

Histologically, age-dependent decreases in areas occupied by hyaluronan and collagenous fibres in the dermis of upper vermilion were demonstrated. Elastic fibre content varied widely between individuals. The area occupied by muscle fibres in the orbicularis oris muscle region within the vermilion also correlated negatively with age. Immunohistochemically, signals of four proteins were attenuated in vermilion from older individuals compared with young individuals: procollagen type I, hyaluronan synthase (HAS)1, myosin heavy chain (MYH)2 (a component of fast-twitch oxidative muscle fibres) and MYH7 (a component of slow-twitch muscle fibres). In contrast, signals of cell migration inducing hyaluronidase 1 (CEMIP) were intensified in vermilion from older individuals. No marked differences between young and older individuals were seen in procollagen type III, HAS2, HAS3, hyaluronidase (HYAL)1, HYAL2, MYH1 or MYH4.

CONCLUSION

Age-dependent decreases of hyaluronan in the dermis of vermilion were prominent, possibly due to both the decrease in synthesis (HAS1) and the increase in degradation (CEMIP). Furthermore, age-dependent decreases in collagenous fibres and two types of muscle fibre in the vermilion were also identified histologically. Type I collagen, MYH2 and MYH7 appear to represent the molecules responsible for these respective decrements.

Characterization and validation of an in vivo confocal Raman spectroscopy led tri-method approach in the evaluation of the lip barrier

Background/Aim

It was the aim to establish and validate in vivo confocal Raman spectroscopy for characterization of the lip barrier in conjunction with transepidermal water loss (TEWL) and skin capacitance assessments. For the first time in vivo, barrier‐relevant components of the lip (derived, natural moisturizing factors (NMFs) and ceramides are described.

Methods

In 32 healthy volunteers, a dental tongue fixation device was inserted to prevent both voluntary and involuntary lip moisturization during measurements. Seventeen individual parameters relating to water, ceramide, and NMF content were assessed via Raman spectroscopy. Additionally, corneometry and TEWL were measured. To give a guidance for the required volunteer group size of future lip barrier studies for all test parameters, coefficients of variation (CV) were calculated and plots showing the required sample size for a given percentage treatment effect.

Results

Raman spectroscopy assessed parameters on the lower lip comprehensively characterized the state of the lip barrier. Parameter variability was sufficiently low to corroborate changes in most parameters using relatively small study populations.

Conclusions

Lip skin is comparatively well hydrated. Biophysical measurement of the lip barrier function is a challenge, as unconscious licking of the lower lip has to be prevented. In vivo confocal Raman spectroscopy provides insightful parameters for the characterization of the lip barrier and sufficiently low inter‐individual variability to assess relatively small parameter changes employing relatively few study subjects. Differences at the molecular level and at a high spatial resolution are detectable, and these insights might provide a breakthrough in the evaluation of lip barrier function and developing solutions for lip care.

Deposition of plant lipids after single application of a lip care product determined by confocal raman spectroscopy, corneometry and transepidermal water-loss

OBJECTIVE

Lip treatment products often incorporate oils and waxes in their formulations, and a desired outcome of their use is to prevent lip dryness and roughness as well as help to repair this condition. The objective of this study was to combine confocal Raman spectroscopy with skin capacitance (corneometry) and transepidermal water loss (closed chamber Aquaflux system) measurements, in the evaluation of the degree of moisturization and lip skin penetration of a fruit wax (Rhus vernicula peel cera) and natural oil-based (Cocos nucifera fruit oil and Olea europea oil) lip care product, following a single application.

METHODS

The study was conducted on a total of 15 healthy female volunteers. Instrumental measurements were performed before and 30 min, 2 h and 6 h after a single application of the product.

RESULTS

Lip skin barrier function as well as lip hydration were significantly improved and penetration of olive oil was maintained for at least 6 h post product application. The deposition of the three component lipids (berry fruit wax, coconut oil and olive oil) into the stratum corneum after a single application of the lip care product was maintained and data significant for 2-6 h post product application. Lipid deposition was regarded as a positive long-lasting skin care (depot-) effect combined with a profound hydrating effect for about 6 h.

CONCLUSION

The tri-method approach taken in this study is deemed relevant and valid for measuring lip hydration offering a complimentary assessment of the barrier function of lip skin and interactive effects of cosmetic ingredients.

Gromwell (Lithospermum erythrorhizon) root extract protects against glycation and related inflammatory and oxidative stress while offering UV absorption capability

Glycation and advanced glycation end products (AGE) damage skin which is compounded by AGE-induced oxidative stress and inflammation. Lip and facial skin could be susceptible to glycation damage as they are chronically stressed. As Gromwell (Lithospermum erythrorhizon) root (GR) has an extensive traditional medicine history that includes providing multiple skin benefits, our objective was to determine whether GR extract and its base naphthoquinone, shikonin, might protect skin by inhibiting glycation, increasing oxidative defenses, suppressing inflammatory responses and offering ultraviolet (UV) absorptive potential in lip and facial cosmetic matrices. We show GR extract and shikonin dose-dependently inhibited glycation and enhanced oxidative defenses through nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element activation. Inflammatory targets, nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) and tumor necrosis factor alpha, were suppressed by GR extract and shikonin. Glyoxalase 1 (GLO1) and glutathione synthesis genes were significantly upregulated by GR extract and shikonin. GR extract boosted higher wavelength UV absorption in select cosmetic matrices. Rationale for the use of GR extract and shikonin are supported by our research. By inhibiting glycation, modulating oxidative stress, suppressing inflammation and UV-absorptive properties, GR extract and shikonin potentially offer multiple skin benefits.

In Vitro Development of a Mucocutaneous Junction for Lip Reconstruction

PURPOSE

We present a straightforward and reproducible technique to create, in vitro, a construct containing a mucocutaneous junction (MCJ) with a transitional zone (vermilion) for fabrication of a microvascular prelaminated flap for use in lip reconstruction.

MATERIALS AND METHODS

Cultured primary human skin keratinocytes and oral mucosal epithelial cells at premixed ratios of 50% skin cells to 50% oral cells, 25% skin cells to 75% oral cells, and 75% skin cells to 25% oral cells were grown on an AlloDerm dermal equivalent (LifeCell, Branchburg, NJ) to create an MCJ equivalent with a lip or transitional zone (vermilion) using a novel 3-dimensional (3D) culture device with a barrier to separate co-cultured skin and oral cells. The 3 different cell ratios were compared by staining for the following specific differentiation markers to define the different areas of skin and mucosal keratinocytes: filaggrin, cytokeratin 10, cytokeratin 19, and small proline-rich protein 3.

RESULTS

Immunohistochemical results showed that MCJ equivalents seeded with premixed cells were similar to the differentiation patterns of tissue-engineered 3D cultures using 100% oral mucosal epithelial cells or skin keratinocytes. The engineered MCJ-equivalent constructs, grown in the 3D device specifically constructed with a cell-free gap at the barrier site, formed a transitional zone (vermilion) at the barrier site with intermingling of the skin and oral keratinocytes. The results showed different and unique expression patterns of filaggrin, cytokeratin 10, cytokeratin 19, and small proline-rich protein 3 by those cells migrating into the gap, which were similar to those seen in human lip tissue. This pattern was not seen in MCJ equivalents created using premixed skin and oral cells.

CONCLUSIONS

Using a device to separately co-culture human oral and skin keratinocytes to allow the cells to migrate into a cell-free zone resulted in phenotypic expression closer to what is seen in native tissue, in comparison to premixing the skin and oral cells before seeding.

Brush biopsy of human oral mucosal epithelial cells as a quality control of the cell source for fabrication of transplantable epithelial cell sheets for regenerative medicine

Autologous oral mucosal epithelial cell sheets have been used for treating epithelial defects such as cornea and esophagus. The cell source of patients' oral mucosal epithelial cell sheet should be examined in normality because it has individual difference. In this study, oral mucosal epithelial cells were less invasively collected by brush biopsy from the buccal, gingival, labial, and palate mucosa of four healthy volunteer donors without anesthesia, and analyzed the keratin expressions by western blotting and the obtained results were compared with those by immunohistochemistry of each of the native tissues. All of the oral mucosal epithelial cells expressed keratin 4 (K4) and K13, which were mucosal stratified squamous epithelial cell markers. K1 and K10, keratinized epithelial cell markers, were also detected in keratinized tissues such as gingival and palate mucosa. The markers of epithelial basal cells such as p63 and K15 were not detected by brush biopsy-western blotting. Although this method does not include basal layers of oral mucosa, protein expressions of upper layer of lesion area are different from normal. Therefore, brush biopsy-western blotting was extremely less invasive and would contribute to quality control of the fabrication of autologous oral mucosal epithelial cell sheets.

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Cell sheet source of patient oral mucosal condition has individual difference.

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A new less invasive method for quality check of human oral mucosal epithelial cells.

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Keratin expressions were examined by brush biopsy western blot.

Relationship between CK19 expression, deregulation of normal keratinocyte differentiation pattern and high risk-human papilloma virus infection in oral and oropharyngeal squamous cell carcinoma

BACKGROUND

Simple epithelial keratins appear early during embryonic development and are expressed in non-stratified, ductal and pseudo-stratified epithelial tissues. CK19, the lowest molecular weight keratin, is also expressed in basal layer of squamous epithelia of mucosal surfaces. Previous studies have shown that High Risk-Human Papilloma Virus (HR-HPV) epithelial infection induces cell immortalization via E6 and E7 viral proteins and this, in turn, impairs cytokeratin expression in cancerous cells lines derived from uterine cervix. Here, we demonstrate the possible relationship between HR-HPV(+) oral/oropharyngeal cancer and the high levels of CK19 expression.

METHODS

We analyzed 38 cases of Oral Squamous Cell Carcinomas/ Oro-Pharyngeal Squamous Cell Carcinomas (OSCCs/OPSCCs) by Immunohistochemistry (IHC) using specific antibody (Ab) detecting CK19, by In Situ Hybridization (ISH) and Polymerase Chain Reaction (PCR) based methods in order to define the HPV infectious status. We also evaluated the variation of CK19 expression in UPCI-SCC-131 (HPV(-)) and UPCI-SCC-154 (HPV(+)) cell lines by immunocytochemistry (ICC) and flow cytometry.

RESULTS

CK19 OSCC/OPSCC score has been identified multiplying percentage of cancer expressing cells to staining intensity. CK19 expression score in OSCCs/OPSCCs was very different between HPV(+) (mean: 288.0 ± 24.3) and HPV(-) cancers (mean: 66.2 ± 96.9). This difference was statistically significant (p < 0.001) with a strong evidence of correlation (p < 0.001; Spearman's R: +0.72). ROC curve analysis was performed on CK19 expression index related to HPV positivity. Heterogeneous areas of immunoreactivity varying in percentage value, intensity and/or localization were observed in normal epithelium, both perilesional and distant from the tumor with important differences between HR-HPV(+) and HR-HPV(-) carcinomas. By ICC and flow cytometry, the two analyzed cell lines were both CK19 positive but showed a different level of expression, in particular it should be noted that the UPCI-SCC-154 (HPV(+)) cell line had a higher expression than UPCI-SCC-131 (HPV(-)).

CONCLUSIONS

In this study we demonstrated, for the first time, strong association between CK19 up-regulation and HR-HPV(+) OSCCs/OPSCCs. This test has a good accuracy. We identified ROC curve with a cut-off > 195 for HR-HPV positive results (Sensitivity: 92.3 %; Specificity: 89.3 %). Furthermore, in OSCC/OPSCC, the CK19 test may be useful in identifying HR-HPV infection, the latter being related to HPV E7 potential to disrupt normal cytokeratin expression pattern.

Use of lower vermilion cross-lip flap for correction of whistle deformity in clinical practice and anatomic study for the secondary cleft lip repair

BACKGROUND

The lower vermilion cross-lip flap is usually indicated for large upper-lip vermilion defects. This article points out the importance of the donor site incision and reveals the significance of incorporation of inferior labial artery in this flap.

MATERIALS AND METHODS

The cadaveric study was designed to measure the vertical distance between the upper most parts of the inferior labial artery to vermilion surface in 22 fresh male cadavers. Tissue specimens were taken from the lower lip at the midline in the sagital plane. Moreover, the histologic sections were stained with hematoxylin-eosin, and the measurements were done under light microscope. Alternatively, the divided-pedicle group study consists of 6 patients with lower vermilion cross-lip flap, in which the pedicles were sent to the laboratory for histologic examination after pedicle division.

RESULTS

The distance between the inferior labial artery and the upper most part of the vermilion border was 2.42 ± 1.67 mm. In 77.27% of cases, the artery was found in the submucosal layer. The histologic examination of the pedicles in 6 patients showed the presence of inferior labial artery, in hematoxylin-eosin staining, in the serial cross sections of 5 pedicles.

CONCLUSIONS

Four-millimeter-deep incision of the lower lip's vermilion will embody the inferior labial artery in lower vermilion cross-lip flap in most of the cases. Moreover, the histologic study of the pedicles revealed that the incorporation of the inferior labial artery in flap pedicle will ensure flap perfusion.

CYFRA 21-1 in urine: a diagnostic marker for endometriosis?

Diagnostic workup of endometriosis usually involves laparoscopic inspection and histological examination of biopsies. Unequivocal laboratory parameters for this ailment have not been available in routine diagnostic evaluations thus far. In this study, we examined urine concentrations of cytokeratin 19 (CYFRA 21-1), a structural protein specific for epithelia. We performed immunoassays for CYFRA 21-1 in urine samples from women afflicted with endometriosis throughout their menstrual cycle. We observed a significant increase in CYFRA 21-1 concentrations, corrected by creatinine levels, in the late follicular phase as compared with the level in healthy controls. We conclude that cyclically increased CYFRA 21-1 concentrations in urine could serve as a valuable noninvasive diagnostic parameter in the workup of clinically manifesting endometriosis.

Architectural characterization of organotypic cultures of H400 and primary rat keratinocytes

Organotypic epithelial structures can be cultured using primary or immortalized keratinocytes. However, there has been little detailed quantitative histological characterization of such cultures in comparison with normal mucosal architecture. The aim of this study is to identify morphological markers of tissue architecture that can be used to monitor tissue structure, maturation, and differentiation and to enable quantitative comparison of organotypic cultures (OCs) with normal oral mucosa. OCs of oral keratinocytes [immortalized H400 or primary rat keratinocytes (PRKs)] were generated using the three scaffolds of de-epidermalized dermis (DED), polyethylene terephthalate (PET), and collagen gels for up to 14 days. Cultures and normal epithelium were analyzed immunohistochemically and by using the semi-quantitative reverse transcriptase polymerase chain reaction (sq-RT-PCR) for E-cadherin, desmoglein-3, plakophilin, involucrin, cytokeratins-1, -5, -6, -10, -13, and Ki67. The epithelial thickness of OCs was measured in stained sections using image processing. Histological analysis revealed that air-liquid interface (ALI) cultures generated stratified organotypic epithelial structures by 14-days. The final thickness of these cultures as well as the degree of maturation/stratification (including stratum corneum formation) varied significantly depending on the scaffold used. For certain scaffolds, the immunohistochemical profiles obtained recapitulated those of normal oral epithelium indicating comparable in vitro differentiation and proliferation. In conclusion, quantitative microscopy approaches enabled unbiased architectural characterization of OCs. The scaffold materials used in the present study (DED, collagen type-I and PET) differentially influenced cell behavior in OCs of oral epithelia. H400 and PRK OCs on DED at the ALI demonstrated similar characteristics in terms of gene expression and protein distribution to the normal tissue architecture.

Tissue engineering of lips and muco-cutaneous junctions: in vitro development of tissue engineered constructs of oral mucosa and skin for lip reconstruction

We report for the first time the fabrication of a three-dimensional tissue structure containing, in a continuous layer, the morphological features of a lip: epidermal skin, vermillion, and oral mucosa. This tissue engineered muco-cutaneous (M/C) equivalent was manufactured using human oral and skin keratinocytes grown on an acellular, nonimmunogenic dermal equivalent (AlloDerm(®)) to produce a tissue equivalent with similar anatomic and handling properties as native human lips. Confirmation of the structural composition of the construct was performed using routine histology and immunohistochemistry by identification of epithelial markers that are differentially expressed in separate anatomic areas of the lips. These full-thickness human lip skin equivalents can be used in surgical lip reconstruction in individuals suffering from lip loss from cancer, congenital deformations, and injuries after accidents. We propose this technique can be used as a general basis for tissue engineering of M/C junctions in other parts of the body, such as anus and vagina.

Localization of keratins 13 and 14 in the lingual mucosa of rats during the morphogenesis of circumvallate papillae

We used fluorescence immunohistochemistry, analysis of differential interference contrast (DIC) images and confocal laser-scanning microscopy in the transmission mode, after staining specimens with toluidine blue, to examine the localization of keratin 13 (K13) and keratin 14 (K14) in the lingual epithelium of fetal and juvenile Sprague-Dawley rats during the prenatal and postnatal morphogenesis of circumvallate papillae. No immunoreactivity specific for K13 and K14 was detected in the lingual epithelium of fetuses on day 15 after conception (E15), at which time the primitive rudiment of the circumvallate papillae was detectable by the thickening of several layers of cuboidal epithelial cells. On E17 and E19, the developing circumvallate papillae were clearly recognizable, consisting of a central papilla and the surrounding sulcus. No immunoreactivity specific for K13 and K14 was evident in the lingual epithelium around these structures at this time. K14-specific immunoreactivity was first detected in the basal layer of the epithelium of the circumvallate papillae on postnatal day 0 (P0) and K13-specific immunoreactivity was detected on P7. Morphogenesis of the circumvallate papillae progressed significantly from P0 to P14, and immunoreactivity specific for K13 and K14 was clearly recognizable after P7. The respective patterns of K13-specific and K14-specific immunoreactivity differed during the development of the circumvallate papillae: K13-specific immunoreactivity was generally evident in cells of the intermediate layer of the epithelium, while K14-specific immunoreactivity was detected in cells of the basal and suprabasal layers. The present results are discussed in the context of the previously determined localization of K13 and K14 in the dorsal epithelium of the anterior part of the rat tongue during its morphogenesis.

The lid wiper and muco-cutaneous junction anatomy of the human eyelid margins: an in vivo confocal and histological study

The inner border of the eyelid margin is critically important for ocular surface integrity because it guarantees the thin spread of the tear film. Its exact morphology in the human is still insufficiently known. The histology in serial sections of upper and lower lid margins in whole-mount specimens from 10 human body donors was compared to in vivo confocal microscopy of eight eyes with a Heidelberg retina-tomograph (HRT II) and attached Rostock cornea module. Behind the posterior margin of the Meibomian orifices, the cornified epidermis stopped abruptly and was replaced by a continuous layer of para-keratinized (pk) cells followed by discontinuous pk cells. The pk cells covered the muco-cutaneous junction (MCJ), the surface of which corresponded to the line of Marx (0.2-0.3 mm wide). Then a stratified epithelium with a conjunctival structure of cuboidal cells, some pk cells, and goblet cells formed an epithelial elevation of typically about 100 μm initial thickness (lid wiper). This continued for 0.3-1.5 mm and formed a slope. The MCJ and lid wiper extended all along the lid margin from nasal to temporal positions in the upper and lower lids. Details of the epithelium and connective tissue were also detectable using the Rostock cornea module. The human inner lid border has distinct zones. Due to its location and morphology, the epithelial lip of the lid wiper appears a suitable structure to spread the tear film and is distinct from the MCJ/line of Marx. Better knowledge of the lid margin appears important for understanding dry eye disease and its morphology can be analysed clinically by in vivo confocal microscopy.

Metabolism of fatty acids and lipid hydroperoxides in human body monitoring with Fourier transform Infrared Spectroscopy

BACKGROUND

The metabolism of dietary fatty acids in human has been measured so far using human blood cells and stable-isotope labeled fatty acids, however, no direct data was available for human peripheral tissues and other major organs. To realize the role of dietary fatty acids in human health and diseases, it would be eager to develop convenient and suitable method to monitor fatty acid metabolism in human.

RESULTS

We have developed the measurement system in situ for human lip surface lipids using the Fourier transform infrared spectroscopy (FTIR) - attenuated total reflection (ATR) detection system with special adaptor to monitor metabolic changes of lipids in human body. As human lip surface lipids may not be much affected by skin sebum constituents and may be affected directly by the lipid constituents of diet, we could detect changes of FTIR-ATR spectra, especially at 3005 to approximately 3015 cm(-1), of lip surface polyunsaturated fatty acids in a duration time-dependent manner after intake of the docosahexaenoic acid (DHA)-containing triglyceride diet. The ingested DHA appeared on the lip surface and was detected by FTIR-ATR directly and non-invasively. It was found that the metabolic rates of DHA for male volunteer subjects with age 60s were much lower than those with age 20s. Lipid hydroperoxides were found in lip lipids which were extracted from the lip surface using a mixture of ethanol/ethylpropionate/iso-octane solvents, and were the highest in the content just before noon. The changes of lipid hydroperoxides were detected also in situ with FTIR-ATR at 968 cm(-1).

CONCLUSION

The measurements of lip surface lipids with FTIR-ATR technique may advance the investigation of human lipid metabolism in situ non-invasively.

Clear cell carcinoma: review of its histomorphogenesis and classification as a squamous cell lesion

In current classification schemes, clear cell carcinoma-including both the hyalinized and nonhyalinized variety--is now an accepted subtype of malignant salivary gland tumors. Despite this, the underlying cellular differentiation process leading to the typical histomorphology of this neoplasm remains unclear. This review summarizes and illustrates the histologic, ultrastructural, and immunohistochemical evidence for the underlying squamous cell nature of clear cell carcinoma. Squamous cell differentiation is not an uncommon feature of nonneoplastic and neoplastic lesions of the salivary glands. Clear cell carcinoma needs to be added to this list as a unique but specific variety of clear cell squamous carcinoma.

Mucocutaneous junction of eyelid and lip: a study of the transition zone using epithelial cell markers

PURPOSE

The expression of epithelial cell markers in the mouse eyelid and lip was investigated in order to understand the nature of the interactions of mucosal and skin epithelium as to how they form the mucocutaneous junction (MCJ).

METHODS

Cryosections of eyelid and lip tissue from normal mice were examined immunohistochemically with cytokeratins (CKs): CK1, CK4, CK5, CK6, CK10, CK13, CK14, and CK19; filaggrin; involucrin; and connexin 43.

RESULTS

The expression pattern varied across the MCJ, with the absence of CK1, CK10, and filaggrin in the mucosal epithelium; and CK4, CK6, and CK13 in the skin epidermis. CK5 and CK14 were consistently expressed in full-thickness skin, MCJ, and mucosa. CK19 was expressed basally, while involucrin-positive cells were found superficially in skin, MCJ, and mucosa. Connexin 43 was present in the MCJ, skin, and labial mucosa; however, little to no expression was seen in the palpebral conjunctiva.

CONCLUSION

The MCJ may be a focal point of mucosal epithelial cell differentiation activities. The similarity of staining patterns in the eyelid and lip suggests that the formation of these sites of shared interaction between the internal and external environment employs similar cellular mechanisms.

Unexpected distribution of surface hydration level of the lip

BACKGROUND

The functional properties of human lips depend on their hydration level. Limited data are, however, available.

OBJECTIVE

To investigate water distribution through the lower lip surface.

METHODS

Images from the surface of the lip were recorded using a new capacitance imaging technique. Capacitance and conductance measurements were also carried out in various points of lower lip and on adjacent skin.

RESULTS

Data clearly show that the closest part of the mucosa of the lip is less hydrated than the external part. These unexpected findings could be related to the presence of a premucosa area whose structure is clearly different from that of vermilion zone.

Newly developed technique for dual localization of keratins 13 and 14 by fluorescence immunohistochemistry

It is difficult to visualize histological details on semi-ultrathin sections by light microscopy after immunohistochemical labeling because the histological structures in such sections cannot be distinguished by standard counterstaining. To solve this problem and to visualize the immunoreactivity of keratins 13 (K13) and 14 (K14), we used a newly developed technique for dual localization of antigens by fluorescence immunohistochemistry and confocal laser-scanning microscopy in transmission mode, after staining specimens with toluidine blue. Using this approach, we examined the immunolocalization of K13 and K14 on the lingual epithelium of fetal and juvenile rats by immunofluorescence while monitoring morphological changes in the filiform papillae by laser-scanning microscopy, in transmission mode, of the same sections. No K13 and K14 immunoreactivity was detected on the lingual epithelium of fetuses on day 15 after conception (E15), at which time the lingual epithelium was composed of a few layers of cuboidal cells. K14 immunoreactivity was first detected on the lingual epithelium of fetuses on E17 and K13 immunoreactivity on E19. The number of layers of cuboidal cells in the lingual epithelium also increased from E17 to E19. K13 and K14 immunoreactivity was distinct at all postnatal stages examined. Although the respective patterns of K13 and K14 immunoreactivity differed as the filiform papillae developed, K13 immunoreactivity was generally evident in the suprabasal cells of the interpapillary cell columns and K14 immunoreactivity was detected in the basal and suprabasal cells of the papillary and interpapillary cell columns. Our newly developed technique for dual localization of antigens should be useful for investigations of very small specimens, such as fetal tissues and organs.

In vivo experimental model of human gingival mucosa using immunodeficient mice

BACKGROUND AND OBJECTIVE

To establish an in vivo experimental model for examining human periodontal tissue, the present study examined several transplant techniques that maintain the structure and characteristics of human gingival mucosa.

MATERIAL AND METHODS

Human oral mucosal tissue samples were collected from the gingiva (n = 11), palate (n = 1), and tongue (n = 3). These mucosal grafts were transplanted onto BALB/c nu/scid mice with double-mutant immunodeficiency. Murine skin, twice the size of the graft, was cut open in an ' square superset'-shape. Next, the connective tissue side of the graft was placed onto the murine connective tissue. Immunohistochemical analysis was also performed, using polyclonal rabbit antibody to involucrin, monoclonal antibody to vimentin, monoclonal antibody to CD34, and monoclonal antibody to Ki-67, to determine whether the characteristics of human oral mucosa were maintained.

RESULTS

When the connective tissue side of the graft was placed on the murine fascial membrane, the histological structure of the graft was maintained for 60 d. These grafts were examined for human characteristics using human-specific antibodies. Immunohistochemically, the expression patterns of involucrin, vimentin, and Ki-67 indicated that transplanted mucosa revealed normal human characteristics, including differentiation and proliferation up to 80 d. CD34 was not detected in the graft endothelial cells.

CONCLUSION

The present study revealed that the novel technique of transplantation of human gingival mucosa in nu/scid mice may serve as an in vivo experimental model of periodontal disease.

Increased CK19 expression correlated with pathologic differentiation grade and prognosis in oral squamous cell carcinoma patients

OBJECTIVE

To investigate cytokeratin 19 (CK19) expression in oral squamous cell carcinoma (OSCC) tissue as well as its correlation with pathologic differentiation grade and prognosis.

STUDY DESIGN

Cancerous and distant tissues from 33 primary OSCC patients were collected during surgery. Each sample was divided into 2 parts, one for CK19 protein detection using immunohistochemistry, and the other for CK19 mRNA-level detection of relative quantification using fluorescent real-time reverse transcriptase polymerase chain reaction (RT-PCR).

RESULTS

The CK19 positive rate in cancerous tissue was 90.9% (30 out of 33) detected using immunohistochemistry, which was significantly higher than that in distant tissue (15.2%, 5 out of 33) by chi-square test (P < .001). The CK19 positive score in cancerous tissue was also significantly higher than that in the corresponding distant tissue by paired samples t test (P < .001). Patients with positive CK19 expression in distant tissue had higher tumor recurrence rate (P = .008) and lower survival rate (P = .015) than those with negative CK19 expression in distant tissue. Using fluorescent real-time RT-PCR, CK19 mRNA level in cancerous tissue was 2.21-fold higher than that in distant tissue (P = .020). The CK19 expression correlated significantly with pathologic differentiation grade, which was detected not only using immunohistochemistry (P = .002) but also using fluorescent real-time RT-PCR (P = .025), poorer differentiated indicating higher CK19 positive score and CK19 mRNA level.

CONCLUSIONS

Increased CK19 protein expression and gene transcription in OSCC tissue correlate significantly with pathologic differentiation grade. Positive CK19 expression in distant tissue suggests a higher tumor recurrence rate and a lower survival rate.

Lupus erythematosus: clinical and histopathological study of oral manifestations and immunohistochemical profile of epithelial maturation

BACKGROUND

Lupus erythematosus (LE) is an autoimmune disease of unknown cause. Prevalence of oral involvement in patients with LE is uncertain but may vary from 9 to 45% in patients with systemic disease and from 3 to 20% in patients with chronic cutaneous involvement.

METHODS

Incidence of oral lesions of LE and their clinical aspects were investigated. Their histopathologic features were analyzed, and the status of epithelial maturation was assessed through the expression patterns of cytokeratins.

RESULTS

Twenty-six patients (from 188 examined) presented oral lesions of LE. Most of them were females (19) with systemic disease (11). Clinical aspects of these lesions varied, and lips and buccal mucosa were most affected. Histologically, lesions revealed lichenoid mucositis with perivascular infiltrate and thickening of basement. Cytokeratins profile showed hyperproliferative epithelium, with expression of CK5/6, and CK14 on all epithelial layers, CK16 on all suprabasal layers and CK10 on prickle cell layers only.

CONCLUSIONS

Oral lesions of LE show a variety of aspects, and their microscopic features are of a lichenoid mucositis with deep inflammatory infiltrate. Cytokeratins expression patterns are of hyperproliferative epithelium, and this phenomenon must be analyzed in relation to the inflammatory cytokines for a better understanding of the mechanisms of the disease.

Increased levels of CK19 mRNA in oral squamous cell carcinoma tissue detected by relative quantification with real-time polymerase chain reaction

Oral squamous cell carcinoma (OSCC) is the most common malignant tumour in the oral and maxillofacial region and has a poor prognosis. Cytokeratin 19 (CK19) is a component of cytoskeleton protein. Previous studies have reported abnormal expression of CK19 protein in OSCC tissue. This study is to investigate the quantitative level of CK19 gene transcript in OSCC tissue as well as its clinical significance. Thirty-one OSCC patients (26 males and 5 females) took part in the present study, aged 34-78 years (mean 58.2 years). The level of CK19 mRNA was detected using fluorescent quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) in cancerous and paracancerous tissues. The relative quantification in cancerous tissue compared with paracancerous tissue was calculated using the 2(-DeltaDeltaCt) equation. The level of CK19 mRNA in cancerous tissue from OSCC patients was 2.21-fold higher than that in paracancerous tissue (P=0.020), and the amplicon was specific without genomic DNA contamination. The level of CK19 mRNA correlated significantly with the pathological differentiation grade of OSCC tissue (P=0.025), with poorer differentiation indicating a higher level of CK19 mRNA. These results suggest that fluorescent quantitative real-time RT-PCR is accurate and reliable for the detection of CK19 gene transcript levels in OSCC tissue. The level of CK19 mRNA was increased in OSCC tissue, and this was significantly correlated with the pathological differentiation grade.