Testosterone stimulates proliferation and inhibits interleukin-6 production of normal and hereditary gingival fibromatosis fibroblasts

The association between sex hormones and periodontitis among American adults: A cross-sectional study

Introduction

After adulthood, as a person grows older, the secretion of sex hormones in the body gradually decreases, and the risk of periodontitis increases. But the relationship between sex hormones and periodontitis is still controversial.

Methods

We investigated the association between sex hormones and periodontitis among Americans over 30 years old. 4,877 participants containing 3,222 males and 1,655 postmenopausal females who had had periodontal examination and detailed available sex hormone levels, were included in our analysis from the 2009-2014 National Health and Nutrition Examination Surveys cycles. We applied multivariate linear regression models to estimate the connection between sex hormones and periodontitis after converting sex hormones into categorical variables through tertile. Additionally, to ensure the stability of the analysis results, we carried out a trend test, subgroup analysis, and interaction test.

Results

After fully adjusting the covariates, estradiol levels were not associated with periodontitis in both males and females with a P for trend = 0.064 and 0.064, respectively. For males, we found that sex hormone-binding globulin was positively associated with periodontitis (tertile3 vs tertile1: OR=1.63, 95% CI=1.17-2.28, p = 0.004, P for trend = 0.005). Congruously, free testosterone (tertile3 vs tertile1: OR=0.60, 95% CI=0.43-0.84, p = 0.003), bioavailable testosterone (tertile3 vs tertile1: OR=0.51, 95% CI=0.36-0.71, p < 0.001), and free androgen index (tertile3 vs tertile1: OR=0.53, 95% CI=0.37-0.75, p < 0.001) was found to be negatively associated with periodontitis. Moreover, subgroup analysis of age found a closer relationship between sex hormones and periodontitis in those younger than 50 years.

Conclusion

Our research suggested that males with lower bioavailable testosterone levels affected by sex hormone-binding globulin were at a higher risk of periodontitis. Meanwhile, estradiol levels were not associated with periodontitis in postmenopausal women.

Periodontal clinical status, microbial profile, and expression of interleukin-1β in men under androgenic anabolic steroids abuse

OBJECTIVES

Androgenic anabolic steroids (AAS) abuse is a serious health problem associated to several systemic complications. Here, we evaluated the periodontal clinical status, microbial profile, and expression of total protein (TP) and interleukin (IL)-1β in men using AAS.

MATERIALS AND METHODS

Men using AAS were recruited (case group) and matched for age with men who had never used AAS (control group) but also performed physical activities. Plaque index (PI), marginal bleeding (MB), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) were evaluated. Crevicular fluid and subgingival biofilm were collected from healthy and diseased sites (PD ≥ 4 mm with CAL ≥ 1 mm and BoP) and evaluated for TP, IL-1β, and proportions of 40 bacterial species.

RESULTS

Thirty patients were included (n = 15/group). AAS consumers had significantly higher mean PD and higher percentage of diseased sites; sites with PD ≥ 4 mm or with CAL ≥ 1 mm than non-consumers. Also, AAS users showed a more dysbiotic biofilm containing lower proportions of host-compatible species and higher proportions of pathogens. IL-1β expression was statistically higher in diseased than in healthy sites only in the control group. A statistically positive correlation was detected between periodontal pathogens and IL-1β expression. The number of AAS cycles was positively associated with higher percentages of periodontal pathogens, but not with IL-1β or total protein concentrations.

CONCLUSIONS

AAS intake can worsen clinical and immunological periodontal conditions and the biofilm composition in healthy sites.

CLINICAL RELEVANCE

Dental care professionals should perform full mouth periodontal screening and schedule regular follow-up appointments for patients under AAS use.

Sex hormone replacement therapy in periodontology-A systematic review

OBJECTIVE

To analyse whether sex hormone replacement therapy (HRT) improves periodontal parameters and dental implants osseointegration in humans.

MATERIALS AND METHODS

Electronic databases and hand searches were performed from June to August 2018 in SciELO, LILACS and PubMed/MEDLINE. Human observational and interventional studies that evaluated the following parameters were included: clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), radiographic bone loss (RBL) or osseointegration.

RESULTS

Initial search retrieved 1,282 non-duplicated articles. Fifteen studies were selected after inclusion criteria were applied. All studies were performed in postmenopausal women. Mean differences for PPD reduction ranged from 0.02 to 0.2 mm in HRT-positive patients; mean CAL gain -0.18 to 0.54 mm; mean RBL reduction -0.87 to 0.15 mm; and mean BOP reduction 9%-30.3%. Failure rate of dental implants increased -5.5% to 11.21% when HRT was used.

CONCLUSIONS

Very low but consistent evidence suggests a reduction in BOP and no impact on RBL in postmenopausal women receiving HRT. There are inconsistent reports that suggest that HRT in postmenopausal women: (a) improves or does not impact PPD reduction and CAL gain; and (b) does not impact or increase implant loss. In summary, there is no evidence to support HRT prescription for either men or women for periodontal/implant placement purposes.

Do Androgens Modulate the Pathophysiological Pathways of Inflammation? Appraising the Contemporary Evidence

The role of testosterone in the pathophysiology of inflammation is of critical clinical importance; however, no universal mechanism(s) has been advanced to explain the complex and interwoven pathways of androgens in the attenuation of the inflammatory processes. PubMed and EMBASE searches were performed, including the following key words: "testosterone", "androgens", "inflammatory cytokines", "inflammatory biomarkers" with focus on clinical studies as well as basic scientific studies in human and animal models. Significant benefits of testosterone therapy in ameliorating or attenuating the symptoms of several chronic inflammatory diseases were reported. Because anti⁻tumor necrosis factor therapy is the mainstay for the treatment of moderate-to-severe inflammatory bowel disease; including Crohn's disease and ulcerative colitis, and because testosterone therapy in hypogonadal men with chronic inflammatory conditions reduce tumor necrosis factor-alpha (TNF-α), IL-1β, and IL-6, we suggest that testosterone therapy attenuates the inflammatory process and reduces the burden of disease by mechanisms inhibiting inflammatory cytokine expression and function. Mechanistically, androgens regulate the expression and function of inflammatory cytokines, including TNF-α, IL-1β, IL-6, and CRP (C-reactive protein). Here, we suggest that testosterone regulates multiple and overlapping cellular and molecular pathways involving a host of immune cells and biochemical factors that converge to contribute to attenuation of the inflammatory process.

Risk of incident benign prostatic hyperplasia in patients with gout: a retrospective cohort study

BACKGROUND

This retrospective cohort study evaluated the association between gout and the risk of benign prostatic hyperplasia among men by using data from Taiwan's National Health Insurance Research Database.

METHODS

Population-based representative insurance (outpatient and inpatient) claims data of 29,269 patients with gout and 29,269 matched patients without gout (1:1 ratio) for the period of 1997-2010 in Taiwan were identified. The association between gout and benign prostatic hyperplasia was evaluated using the Cox proportional hazards model. The associations of age by gout and gout phenotypes with benign prostatic hyperplasia risk were estimated.

RESULTS

Patients with gout had a higher incidence rate of benign prostatic hyperplasia than those in the matched gout-free group (19.62 vs. 10.11 events per 1000 person-years). Compared with the gout-free group, the adjusted hazard ratios (HRs) (95% confidence intervals (CIs)) for benign prostatic hyperplasia were 1.30 (1.24-1.36). The gout-to-benign prostatic hyperplasia association was modified by age (P_interaction < 0.0001) in gout patients the age groups of 20-40 years (adjusted HR 2.74, P < 0.0001) and 41-60 years (adjusted HR 1.39, P < 0.0001) but not in the age group of >60 years (adjusted HR 1.07, P = 0.063). Compared with gouty tophi, a higher risk of benign prostatic hyperplasia was noted in gouty nephropathy (adjusted HR 1.30, 95% CI 1.12-1.50).

CONCLUSIONS

Our results suggest that male gout is positively related to benign prostatic hyperplasia, particularly in young gout patients and those with gouty nephropathy.

"Low Testosterone Levels in Body Fluids Are Associated With Chronic Periodontitis"

There is a debate over the association between low testosterone levels in body fluids and the occurrence of chronic periodontitis (CP). The aim of the present systematic review was to assess whether low testosterone levels in body fluids reflect CP. In order to identify studies relevant to the focus question: “Is there a relationship between low testosterone levels in body fluids and CP?” an electronic search without time or language restrictions was conducted up to June 2016 in indexed databases using different keywords: periodontitis, chronic periodontitis, periodontal diseases, testosterone, and gonadal steroid hormones. A total of eight studies were included in the present systematic review. The number of study participants ranged from 24 to 1,838 male individuals with ages ranging from 15 to 95 years. Seven studies measured testosterone levels in serum, two studies in saliva, and one study in gingiva. Four studies reported a negative association between serum testosterone levels and CP. Two studies reported a positive association between decreased testosterone levels in serum and CP. Increased levels of salivary testosterone among patients with CP were reported in one study; whereas one study reported no significant difference in the concentration of salivary testosterone between patients with and without CP. One study identified significant increase in the metabolism of testosterone in the gingiva of patients with CP. Within the limits of the evidence available, the relationship between low testosterone levels and CP remains debatable and further longitudinal studies and control trials are needed.

Role of testosterone in regulating induction of TNF-α in rat spleen via ERK signaling pathway

Spleen is a pivotal organ for regulating immune homeostasis. It has been shown that testosterone diminishes secretion of various inflammatory molecules under multiple conditions. However, the mechanisms of action of endogenous testosterone affecting immune responses in the spleen remain unknown. The aim of the present study was to evaluate the immune functions of the spleen in response to testosterone withdrawal after orchidectomy, and the impact of splenocytes on the bacterial endotoxin lipopolysaccharide (LPS)-induced secretion of inflammatory molecules. Male rats were divided into 3 groups, i.e. intact, orchidectomized (Orch) and orchidectomized plus replacement of testosterone propionate (TP) (Orch+TP). The Orch and Orch+TP rats underwent bilateral orchidectomy one week before TP replacement (2mg/kg body weight) or sesame oil in intact rats as controls for seven days. Orch resulted in a significant increase of spleen weight and basal secretion of nitric oxide (NO) from splenocytes. Additionally, LPS up-regulated cell proliferation and the secretion of tumor necrosis factor-alpha (TNF-α) in splenocytes of Orch rats. Orch further up-regulated phosphorylation of extracellular signal-regulated kinases. Interestingly, the plasma corticosterone concentration in the Orch group was higher than that in the intact and Orch+TP groups. Deficiency of testosterone-elevated TNF-α and NO secretion in response to LPS were confirmed in the rat splenocytes. Testosterone also significantly attenuated LPS-elicited release of TNF-α and NO in a dose-dependent manner. However, testosterone did not suppress splenic blastogenesis at doses in the 10(-10)-10(-7)M concentration range. In this context, testosterone might have a protective role against inflammatory responses in the spleen. The present study provides evidence to indicate that testosterone might modulate the immune system.

Androgen receptors and experimental bone loss - an in vivo and in vitro study

Testosterone is a sex hormone that exhibits many functions beyond reproduction; one such function is the regulation of bone metabolism. The role played by androgen receptors during testosterone-mediated biological processes associated with bone metabolism is largely unknown. This study aims to use a periodontal disease model in vivo in order to assess the involvement of androgen receptors on microbial-induced inflammation and alveolar bone resorption in experimental bone loss. The impact of hormone deprivation was tested through both orchiectomy and chemical blockage of androgen receptor using flutamide (FLU). Additionally, the direct effect of exogenous testosterone, and the role of the androgen receptor, on osteoclastogenesis were investigated. Thirty male adult rats (n=10/group) were subjected to: 1-orchiectomy (OCX); 2-OCX sham surgery; or 3-OCX sham surgery plus FLU, four weeks before the induction of experimental bone loss. Ten OCX sham-operated rats were not subjected to experimental bone loss and served as healthy controls. The rats were euthanized two weeks later, so as to assess bone resorption and the production of inflammatory cytokines in the gingival tissue and serum. In order to study the in vitro impact of testosterone, osteoclasts were differentiated from RAW264.7 cells and testosterone was added at increasing concentrations. Both OCX and FLU increased bone resorption, but OCX alone was observed to increase osteoclast count. IL-1β production was increased only in the gingival tissue of OCX animals, whereas FLU-treated animals presented a decreased expression of IL-6. Testosterone reduced the osteoclast formation in a dose-dependent manner, and significantly impacted the production of TNF-α; FLU partially reversed these actions. When taken together, our results indicate that testosterone modulates experimental bone loss, and that this action is mediated, at least in part, via the androgen receptor.

ALPK1 affects testosterone mediated regulation of proinflammatory cytokines production

Alpha-protein kinase 1, also known as alpha-kinase 1 (ALPK1), is associated with chronic kidney disease (CKD), myocardial infarction, gout and type 2 diabetes mellitus (DM). In addition to having an inductive effect on the proinflammatory cytokines in monocytic THP1 cells, ALPK1 is expressed abundantly in the mouse testes. Low testosterone levels are commonly associated with arthritis, CKD, type 2 DM, cardiovascular disease and inflammation. The testosterone's anti-inflammatory effect has been demonstrated to reduce proinflammatory cytokines and adhesion molecules. In this study, we found that ALPK1 transgenic mice showed lower levels of testosterone in both the testes and the serum. Decreasing endogenous ALPK1 enhanced testosterone levels and transcripts of testosterone-regulated genes (P450scc, 3beta-HSD, P450C17, 17beta-HSD, StAR, and INSL3) in TM3 Leydig cells. In contrast, increasing testosterone decreased ALPK1 in both TM3 and monocytic THP1 cells. This decrease was accompanied by a reduction of the proinflammatory cytokines. Increased ALPK1 levels attenuated the testosterone effects in THP1 cells. Finally, we also found that ALPK1 increased the release of TNF-alpha and TGF-beta1 in the human embryonic kidney 293 cells, while testosterone inhibited ALPK1 in the primary kidney cells. Taken together, this data suggests that the balance between ALPK1 and testosterone plays a critical role in the testosterone-mediated inhibition of proinflammatory cytokines.

Dietary Vitamin D3 Restriction Exacerbates Disease Pathophysiology in the Spinal Cord of the G93A Mouse Model of Amyotrophic Lateral Sclerosis

Background

Dietary vitamin D₃ (D₃) restriction reduces paw grip endurance and motor performance in G93A mice, and increases inflammation and apoptosis in the quadríceps of females. ALS, a neuromuscular disease, causes progressive degeneration of motor neurons in the brain and spinal cord.

Objective

We analyzed the spinal cords of G93A mice following dietary D₃ restriction at 2.5% the adequate intake (AI) for oxidative damage (4-HNE, 3-NY), antioxidant enzymes (SOD2, catalase, GPx1), inflammation (TNF-α, IL-6, IL-10), apoptosis (bax/bcl-2 ratio, cleaved/pro-caspase 3 ratio), neurotrophic factor (GDNF) and neuron count (ChAT, SMI-36/SMI-32 ratio).

Methods

Beginning at age 25 d, 42 G93A mice were provided food ad libitum with either adequate (AI;1 IU D₃/g feed; 12 M, 11 F) or deficient (DEF; 0.025 IU D₃/g feed; 10 M, 9 F) D₃. At age 113 d, the spinal cords were analyzed for protein content. Differences were considered significant at P ≤ 0.10, since this was a pilot study.

Results

DEF mice had 16% higher 4-HNE (P = 0.056), 12% higher GPx1 (P = 0.057) and 23% higher Bax/Bcl2 ratio (P = 0.076) vs. AI. DEF females had 29% higher GPx1 (P = 0.001) and 22% higher IL-6 (P = 0.077) vs. AI females. DEF males had 23% higher 4-HNE (P = 0.066) and 18% lower SOD2 (P = 0.034) vs. AI males. DEF males had 27% lower SOD2 (P = 0.004), 17% lower GPx1 (P = 0.070), 29% lower IL-6 (P = 0.023) and 22% lower ChAT (P = 0.082) vs. DEF females.

Conclusion

D₃ deficiency exacerbates disease pathophysiology in the spinal cord of G93A mice, the exact mechanisms are sex-specific. This is in accord with our previous results in the quadriceps, as well as functional and disease outcomes.

Differential responses to steroid hormones in fibroblasts from the vocal fold, trachea, and esophagus

There is accumulating evidence that fibroblasts are target cells for steroids such as sex hormones and corticoids. The characteristics of fibroblasts vary among tissues and organs. Our aim in this study is to examine differences in responses to steroid hormones among fibroblasts from different cervicothoracic regions. We compared the actions of steroid hormones on cultured fibroblasts from the vocal folds, which are considered to be the primary target of steroid hormones, and the trachea and esophagus in adult male rats. Expression of steroid hormone receptors (androgen receptor, estrogen receptor α, and glucocorticoid receptor) was identified by immunofluorescence histochemistry. Androgen receptor was much more frequently expressed in fibroblasts from the vocal fold than in those from the trachea and esophagus. Cell proliferation analysis showed that administration of testosterone, estradiol, or corticosterone suppressed growth of all 3 types of fibroblasts. However, mRNA expression for extracellular matrix-associated genes, including procollagen I and III and elastin, and hyaluronic acid synthase I was elevated only by addition of testosterone to fibroblasts from the vocal fold. These results indicate that each steroid hormone exerts region-specific effects on cervicothoracic fibroblasts with different properties through binding to specific receptors.

Anabolic steroids affect human periodontal health and microbiota

OBJECTIVES

This study aims to evaluate periodontal microbiological differences between systemically healthy nonsmoker males taking anabolic androgenic steroids (AASs) and non-AAS users and to find associations between disease severity and AAS use.

METHODS

Ninety-two men practicing bodybuilding were included in the study. They were divided into AAS users and a matched control nonuser group and subgrouped based on their most severe periodontal condition. Pooled subgingival samples from each individual were cultured to evaluate specific periodontopathogen infection.

RESULTS

AAS users had significantly higher prevalence of severe periodontitis. AAS users had greater gingival inflammation and clinical attachment loss of ≥ 3 mm than nonusers (odds ratio (OR) = 2.4; p = 0.09; 95 % confidence interval (CI) 0.8-6.4). AAS users were 4.9 times more likely to be infected with Prevotella intermedia than AAS nonusers (OR = 4.9; p = 0.003; 95 % CI 1.6-14.7). The OR of presenting subgingival Aggregatibacter actinomycetemcomitans was 8.2 times higher in AAS users (OR = 8.2; p = 0.03; 95 % CI 0.9-70.8). AAS users were 5.6 times more likely to present subgingival Candida spp. than nonusers (OR = 5.6; p = 0.02; 95 % CI 1.1-27.1). AAS users were 14.8 times more likely to present subgingival Candida parapsilosis than nonusers (OR = 14.8; p < 0.0001; 95 % CI 3.1-69.2). The likelihood of AAS users presenting subgingival Candida tropicalis was 4.3 times higher than nonusers (OR = 4.3; p = 0.03; 95 % CI 1.1-16.9). A. actinomycetemcomitans was mostly isolated in individuals with severe periodontitis and was associated with subgingival Porphyromonas gingivalis, P. intermedia, and Candida spp.

CONCLUSIONS

AAS use may increase the risk for severe periodontitis and may cause a subgingival selection of certain Candida species. Specific periodontopathogens, such as Candida dubliniensis and Candida albicans, seem to be negatively affected by AAS use. The higher risk for disease progression in AAS users may be explained by the significantly higher proportions of A. actinomycetemcomitans, P. gingivalis, P. intermedia, and Candida species as compared to controls.

CLINICAL SIGNIFICANCE

Data on the influence of AAS on subgingival periodontopathogens and disease progression are scarce. Higher proportions of specific periodontopathogens are plausible in AAS users. AAS users had a higher prevalence of severe periodontitis, gingival inflammation, and clinical attachment loss. Men taking AAS are at greater risk of periodontitis and specific periodontopathogen infection.

Long term follow up of idiopathic gingival enlargement associated with chronic periodontitis: A case report and review

BACKGROUND

Idiopathic gingival enlargement is a rare condition characterized by massive enlargement of the gingiva. It may be associated with other diseases/conditions characterizing a syndrome, but rarely associated with periodontitis.

CASE DESCRIPTION

This case report describes an unusual clinical form of gingival enlargement associated with chronic periodontitis. Clinical examination revealed diffuse gingival enlargement. The lesion was asymptomatic, firm, and pinkish red. Generalized periodontal pockets were observed. Radiographic evaluation revealed generalized severe alveolar bone loss. Histopathological investigations revealed atrophic epithelium with dense fibrocollagenous tissue. Lesions healed successfully following extraction and surgical excision, and no recurrence was observed after 1 year follow-up but recurrence was observed at 3 and 5-years follow-up.

CLINICAL IMPLICATIONS

Successful treatment of idiopathic gingival enlargement depends on proper identification of etiologic factors and improving esthetics and function through surgical excision of the over growth. However, there may be recurrence.

Testosterone exerts selective anti-inflammatory effects on human skin mast cells in a cell subset dependent manner

Androgens are known to exert anti-inflammatory effects but their impact on mast cells (MCs) remains to be determined. Here, we show that MCs isolated from human foreskin samples (male) and those from breast skin (female) express the androgen receptor, albeit with a 10-fold difference between the subsets. While fundamental MC properties (FcεRI, c-Kit, tryptase; histamine release upon FcεRI cross-linking) were unaffected or slightly reduced (chymase) by testosterone, the hormone had a more profound impact on the production of cytokines, with IL-6 being a target (reduction by 53%). Interestingly, this effect was limited to breast skin MCs (15 of 16 donors displayed this phenomenon), but was not reproduced by foreskin MCs. Collectively, effector functions of human skin MCs are modulated by androgens in a gene-selective and MC subset-specific fashion. Possibly, MCs from women are more susceptible to testosterone. We also demonstrate that MC IL-6 production is highly variable among individuals.

Effects of androgens on cultured cells derived from canine anterior cruciate ligament

Anterior cruciate ligament (ACL) fibroblasts obtained from beagle dogs were cultured in basal medium containing different concentrations of 1 to 10(-3) µM 5α-dihydrotestosterone (DHT) and in basal medium itself as a control. It was demonstrated that DHT promoted cell proliferation activity, expression of androgen receptor, and collagen synthesis in ACL fibroblasts as compared with control. These results suggest that sex hormones are involved in the sex difference seen in ACL rupture of dogs.

Clinical significance of interleukin (IL)-6 in cancer metastasis to bone: potential of anti-IL-6 therapies

Metastatic events to the bone occur frequently in numerous cancer types such as breast, prostate, lung, and renal carcinomas, melanoma, neuroblastoma, and multiple myeloma. Accumulating evidence suggests that the inflammatory cytokine interleukin (IL)-6 is frequently upregulated and is implicated in the ability of cancer cells to metastasize to bone. IL-6 is able to activate various cell signaling cascades that include the STAT (signal transducer and activator of transcription) pathway, the PI3K (phosphatidylinositol-3 kinase) pathway, and the MAPK (mitogen-activated protein kinase) pathway. Activation of these pathways may explain the ability of IL-6 to mediate various aspects of normal and pathogenic bone remodeling, inflammation, cell survival, proliferation, and pro-tumorigenic effects. This review article will discuss the role of IL-6: 1) in bone metabolism, 2) in cancer metastasis to bone, 3) in cancer prognosis, and 4) as potential therapies for metastatic bone cancer.

Palatal Tissue Enlargement After Subepithelial Connective Tissue Graft Harvest Associated With Anabolic Steroid Abuse

INTRODUCTION

Healing complications associated with androgenic anabolic steroid (AAS) abuse have received minimal attention in the periodontal literature. This case report describes an adverse healing event after palatal subepithelial connective tissue graft (SECTG) harvest associated with AAS abuse.

CASE PRESENTATION

A 35-year-old white male was treated with an SECTG procedure to address gingival recession on the facial aspect of teeth #24 and #25. Donor tissue was harvested from the left hard palate via a single incision technique. The procedure was completed without complication. One week postoperatively, the patient presented with a large asymptomatic overgrowth of tissue from the palatal harvest site. Over the following 5 weeks of continued observation, the lesion demonstrated progressive, spontaneous resolution. Investigation of possible etiology revealed the subject was a recreational bodybuilder with admitted AAS abuse.

CONCLUSIONS

Post-surgical healing can be influenced by AAS abuse. Alterations in connective tissue metabolism and fibroblast activity are known sequelae of AAS abuse; however, patients may be reluctant to admit to steroid abuse during the presurgical interview. Surgeons should suspect the possibility of AAS abuse when postoperative complications present in a patient of muscular body type.

Periodontal status in men with hypergonadotropic hypogonadism: effects of testosterone deficiency

BACKGROUND

The purpose of this clinical study was to evaluate the possible influence of testosterone hormone on common clinical measurements of periodontal disease in men with hypergonadotropic hypogonadism.

METHODS

Twenty-four hypergonadotropic hypogonadal men (H) and 24 systemically healthy men (S) were divided into two groups as chronic periodontitis and clinically healthy controls after clinical examinations and radiographs. The H group consisted of 12 control (H/C) and 12 chronic periodontitis (H/P) patients, and the S group consisted of 12 control (S/C) and 12 chronic periodontitis (S/P) patients. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (CAL) scores were recorded.

RESULTS

The mean of all clinical parameters (PI, GI, BOP, PD, and CAL) were significantly (P<0.05) higher in periodontitis groups (H/P and S/P) than controls (H/C and S/C). There were no significant differences in the PD and CAL scores between periodontitis groups (S/P and H/P). The mean of GI and BOP scores were statistically higher in the H/P group than the S/P group (P<0.05). There was a negative correlation between GI and free testosterone levels (r=-0.794; P<0.05).

CONCLUSION

According to these results, serum testosterone levels may possibly influence periodontal disease in men, and testosterone may have an inhibitory effect on gingival inflammation.

The Effects of Anabolic Androgenic Steroid Abuse on Gingival Tissues

BACKGROUND

Anabolic androgenic steroid (AAS) is the familiar name for synthetic derivatives of the male sex hormone, testosterone. A large number of young adults abuse AAS to enhance performance and physical appearance. The aim of this study was to evaluate the effects of AAS abuse on the gingival tissues in a group of bodybuilders and weight lifters.

METHODS

The test group was composed of 24 athletes aged between 17 and 29 years who had been using AAS for >1 year. All subjects were clinically examined for plaque levels (plaque index), gingival inflammation (gingival index), and gingival enlargement. The results were compared to a control group of 20 bodybuilders who had never used AAS drugs and who matched for age, educational level, and oral habits according to the data obtained from the test group.

RESULTS

Although there were no statistical differences between the plaque index (P>0.05) and gingival index (P>0.05) scores of the study group and the control group, the AAS abusers had statistically higher scores of gingival thickness, extent of gingival encroachment, and total gingival enlargement scores (P<0.001 each) compared to non-users.

CONCLUSIONS

The results of this study have revealed that the prolonged use of AAS is closely associated with significant levels of gingival enlargement. Because recreational abuse and abuse in non-competitive sports seem to increase despite legislation, dentists and periodontists should be familiar with the adverse effects of these synthetic derivatives of testosterone on the gingival tissues.

Hereditary Gingival Fibromatosis: A Systematic Review

Generalized gingival enlargement can be caused by a variety of etiological factors. It can be inherited (hereditary gingival fibromatosis [HGF]); associated with other diseases characterizing a syndrome; or induced as a side effect of systemic drugs, such as phenytoin, cyclosporin, or nifedipine. HGF, previously known as elephantiasis gingivae, hereditary gingival hyperplasia, and hypertrophic gingiva, is a genetic disorder characterized by a progressive enlargement of the gingiva. This review will focus on diagnosis, treatment, and control of HGF. The pattern of inheritance, the histopathologic characteristics, and the known biologic and genetic features associated with HGF are also emphasized.

Androgens modulate the inflammatory response during acute wound healing

Impaired wound healing states in the elderly lead to substantial morbidity and mortality, and a cost to the health services of over 9 billion dollars per annum. In addition to intrinsic ageing processes that per se cause delayed healing, studies have suggested marked differences in wound repair between the sexes. We have previously reported that, castration of male mice results in a striking acceleration of local cutaneous wound healing and dampens the associated inflammatory response. In this study, we report that systemic 5alpha-reductase inhibition, which blocks the conversion of testosterone to its more active metabolite 5alpha-dihydrotestosterone, mimics the effects of castration in a rat model of cutaneous wound healing. The mechanisms underlying the observed effects involve a direct, cell-specific upregulation of pro-inflammatory cytokine expression by macrophages, but not fibroblasts, in response to androgens. Androgens require the transforming growth factor beta signalling intermediate Smad3 to be present in order to influence repair and local pro-inflammatory cytokine levels. That reducing 5alpha-dihydrotestosterone levels through 5alpha-reductase antagonism markedly accelerates healing suggests a specific target for future therapeutic intervention in impaired wound healing states in elderly males.

Constitutive activation of p38 and ERK1/2 MAPKs in epithelial cells of myasthenic thymus leads to IL-6 and RANTES overexpression: effects on survival and migration of peripheral T and B cells

Myasthenia gravis (MG) is an autoimmune disease of neuromuscular junctions where thymus plays a pathogenetic role. Thymectomy benefits patients, and thymic hyperplasia, a lymphoid infiltration of perivascular spaces becoming site of autoantibody production, is recurrently observed. Cytokines and chemokines, produced by thymic epithelium and supporting survival and migration of T and B cells, are likely to be of great relevance in pathogenesis of thymic hyperplasia. In thymic epithelial cell (TEC) cultures derived "in vitro" from normal or hyperplastic age-matched MG thymuses, we demonstrate by gene profiling analysis that MG-TEC basally overexpress genes coding for p38 and ERK1/2 MAPKs and for components of their signaling pathways. Immunoblotting experiments confirmed that p38 and ERK1/2 proteins were overexpressed in MG-TEC and, in addition, constitutively activated. Pharmacological blockage with specific inhibitors confirmed their role in the control of IL-6 and RANTES gene expression. According to our results, IL-6 and RANTES levels were abnormally augmented in MG-TEC, either basally or upon induction by adhesion-related stimuli. The finding that IL-6 and RANTES modulate, respectively, survival and migration of peripheral lymphocytes of myasthenic patients point to MAPK transcriptional and posttranscriptional abnormalities of MG-TEC as a key step in the pathological remodelling of myasthenic thymus.

Hereditary Gingival Fibromatosis: Report of a Five-Generation Family Using Cellular Proliferation Analysis

BACKGROUND

Hereditary gingival fibromatosis (HGF) is an uncommon condition characterized by an accumulation of extracellular matrix resulting in a fibrotic enlargement of the gingiva. The goal of this article is to describe one kindred affected with HGF and discuss the diagnosis, treatment, and control of the disease. The pattern of inheritance, histopathologic characteristics, and proliferative potential of epithelial and mesenchymal cells of HGF are also emphasized.

METHODS

To characterize the pattern of inheritance and the clinical appearance of gingival overgrowth, 117 family members were examined. The recurrence risk was estimated by the use of a genetic analysis program. Immunohistochemistry against the proliferating cell nuclear antigen (PCNA) and pKi-67 was performed to assess cellular proliferation of normal gingiva (NG) and HGF cells.

RESULTS

Examination of the family pedigree demonstrated an autosomal dominant trait of inheritance, and a sibling recurrence risk of 0.085 and an offspring recurrence risk of 0.078, indicating that HGF was a consequence of genetic alteration with low penetrance. Unaffected and affected members transmitted the disease to their offspring. The affected patients showed a generalized but mild gingival overgrowth. Surgical treatment consisted of a combination of gingivectomy and gingivoplasty. Histologic examination showed that the gingival lesions of all patients were quite similar, with increased amounts of collagen fiber bundles in the connective tissue. Immunohistochemistry revealed that the proliferative potential of epithelial cells was significantly higher in the HGF group compared to the NG group, whereas mesenchymal cells from both groups were negative for the proliferative markers.

CONCLUSION

Our data demonstrated that, in the studied family, HGF is transmitted by an autosomal dominant pattern with incomplete disease penetrance, and although the gingival enlargement resulted from an excessive accumulation of collagen fibers, HGF is characterized by an increase in the proliferation rate of epithelial cells.

Cyclosporin But Not Tacrolimus Significantly Increases Salivary Cytokine Contents in Rats

BACKGROUND

Cyclosporin (CsA) and tacrolimus (FK-506) are immunosuppressive drugs that specifically inhibit T-cell activation via calcineurin inhibition. Gingival overgrowth is a common side effect following the administration of CsA. The severity of gingival overgrowth seen in patients taking FK-506 is less than that observed with CsA. Little is known about the involvement of saliva in drug-induced gingival overgrowth. The purpose of this study was to investigate the salivary contents of tumor growth factor beta1 (TGF-beta1), epidermal growth factor (EGF), and interleukin-6 (IL-6) as well as the hystometry of gingival tissue obtained from rats treated with either FK-506 or CsA.

METHODS

For 30 or 60 days rats received daily subcutaneous injection doses of either CsA or FK-506 (10 mg/kg). The concentrations of TGF-beta1, EGF, and IL-6 in saliva were determined by enzyme-linked immunosorbent assay, and after histological processing, the oral epithelium and connective tissue were assessed at the region of the lower first molars.

RESULTS

The levels of TGF-beta1, EGF, and IL-6 in saliva were not significantly altered by any of the treatments after 30 days. After 60 days of treatment with CsA, gingival overgrowth and significant increase in salivary TGF-beta1, EGF, and IL-6 concentrations were observed; no statistically significant changes were induced by FK-506.

CONCLUSION

Within the limits of this experimental study, it can be concluded that CsA, but not FK-506, induced gingival overgrowth associated with an increase of the salivary levels of the cytokines TGF-beta1, EGF, and IL-6.

Proliferation of Fibroblasts Cultured From Normal Gingiva and Hereditary Gingival Fibromatosis Is Dependent on Fatty Acid Synthase Activity

BACKGROUND

Fatty acid synthase (FAS) is the enzyme that synthesizes palmitate from malonyl-CoA and acetyl-CoA. Recent studies have shown that FAS is overexpressed in human cancers and that its activity is necessary for cell proliferation. Hereditary gingival fibromatosis (HGF) is a genetic disease manifested as a progressive enlargement of the gingiva. The pathogenesis of this condition is not understood; however, a proliferative advantage of HGF fibroblasts in comparison with cells from normal gingiva (NG) has been described. The aim of this study was to investigate the role of FAS in NG and HGF fibroblast proliferation.

METHODS

NG and HGF fibroblasts had their proliferative potential assessed by automated cell counting and immunocytochemistry against Ki-67 or proliferating cell nuclear antigen (PCNA). The production of FAS, androgen receptor (AR), and ErbB2 was analyzed by Western blot and the pattern of FAS expression studied by immunocytochemistry. FAS activity was blocked by the specific inhibitor cerulenin.

RESULTS

Higher proliferation rates were found in fibroblasts isolated from HGF than from NG. HGF fibroblasts with greater proliferative potential produced more FAS and AR than the cell lines with lower growth rates, and all studied cell lines produced similar amounts of the ErbB2 protein. In addition, the FAS inhibitor cerulenin was able to significantly reduce the proliferation of both NG and HGF cells.

CONCLUSIONS

These results show that FAS is expressed by gingival fibroblasts and that highly proliferative HGF cells produced more FAS and AR than the other fibroblast cell lines. Moreover, FAS inhibition significantly reduced both NG and HGF fibroblast growth, suggesting a role for the androgen-driven fatty acid biosynthesis in their proliferation.

Hepatic apoptosis and proliferation in male and female rats fed alcohol: role of cytokines

BACKGROUND

The female liver is more sensitive to the toxic effect of chronic alcohol intake than the male liver. The aim of the study was to compare the influence of gender and sex hormonal status on apoptosis and cell proliferation following chronic ethanol intake.

METHODS

Male and female rats were pair fed for 8 weeks a liquid diet containing 36% of their total daily calories as ethanol (ETOH group) or sucrose (control group). Liver samples were analyzed for apoptosis and hepatocyte proliferation by immunohistochemistry. The hepatic production of factors able to influence cell death and proliferation, such as tumor necrosis factor alpha (TNFalpha) and interleukin 6 (IL-6) were determined.

RESULTS

In both male and female rats, ethanol intake promoted apoptosis in the liver. This effect of ethanol was more evident in female than male rat livers. Hepatic TNFalpha levels, which promote apoptosis, are significantly more elevated in female than in male livers. Hepatic IL-6 production, which promotes hepatocyte proliferation, was induced by ethanol only in males, but not female animals.

CONCLUSION

This observed difference in cytokine responses may contribute to the enhanced sensitivity of female liver to EtOH-induced injury.