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Demystifying Esophageal Lichen Planus: A Comprehensive Review of a Rare Disease You Will See in Practice. Am J Gastroenterol 2022; 117:70-77. [PMID: 34591036 DOI: 10.14309/ajg.0000000000001485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that often affects the skin, hair, nails, and mucus membranes. Although esophageal involvement has traditionally been felt to be rare, recent reports suggest that it is often unrecognized or misdiagnosed. The diagnoses of esophageal lichen planus can be challenging and is suspected based on patients' endoscopic and histologic findings and in the context of their clinical history and physical examination. Physicians must have an index of suspicion, particularly in older white women and in those patients with an atypical esophagitis or stricturing disease, which do not respond to traditional treatment. Currently, there are limited data on esophageal lichen planus patients, and no formal management guidelines for this disease, which all gastroenterologists will see in practice. This article reviews the etiology and histopathology of LP and provides a comprehensive discussion of the clinical features, diagnosis, and management of esophageal disease from the gastroenterologist's perspective. Finally, we address the esophageal complications of LP.
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Georgescu SR, Tampa M, Mitran MI, Mitran CI, Sarbu MI, Nicolae I, Matei C, Caruntu C, Neagu M, Popa MI. Potential pathogenic mechanisms involved in the association between lichen planus and hepatitis C virus infection. Exp Ther Med 2018; 17:1045-1051. [PMID: 30679972 DOI: 10.3892/etm.2018.6987] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Lichen planus (LP) is an immune-mediated inflammatory disease that particularly affects the skin and mucous membranes. Its etiology remains elusive, however some trigger factors, including viral or bacterial antigens, drugs and metals, have been postulated. There is a higher prevalence of hepatitis C virus (HCV) infection among patients with LP, with some geographical variations. HCV is an enveloped RNA virus that belongs to the Flaviviridae family and in most instances causes chronic liver infections. It has been hypothesized that HCV may contribute to LP development, but the link between the two disorders is not fully understood. It is still debatable whether HCV leads to the occurrence of LP lesions directly by replication inside the infected cells or indirectly by activating immunological pathways. Molecular studies have revealed HCV RNA in specimens collected from patients with LP. The autoimmune theory was also suggested given that several studies have revealed viral replication and immune response activation associated with autoantibody synthesis. The aim of this review is to summarize the main potential mechanisms involved in the association between LP and HCV infection. Understanding the link between the two disorders may shed some light on the pathogenesis of LP, which is a challenging issue.
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Affiliation(s)
- Simona Roxana Georgescu
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mircea Tampa
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Madalina Irina Mitran
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Microbiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristina Iulia Mitran
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania.,Department of Microbiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria Isabela Sarbu
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ilinca Nicolae
- Department of Dermatology, 'Victor Babes' Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania
| | - Clara Matei
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Constantin Caruntu
- Department of Dermatology, 'Prof. N. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania.,Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Monica Neagu
- Department of Immunology, 'Victor Babes' National Institute of Pathology, 050096 Bucharest, Romania.,Faculty of Biology University of Bucharest, 050095 Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,'Cantacuzino' National Medico-Military Institute for Research and Development, 050096 Bucharest, Romania
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Wang Y, Shang S, Sun Q, Chen J, Du G, Nie H, Han X, Tang G. Increased infiltration of CD11 c +/CD123 + dendritic cell subsets and upregulation of TLR/IFN-α signaling participate in pathogenesis of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:459-467.e2. [PMID: 29429903 DOI: 10.1016/j.oooo.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/22/2017] [Accepted: 12/03/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Investigation of dendritic cell (DC) subsets and expression patterns of Toll-like receptors (TLRs) was conducted to understand the pathogenesis in oral lichen planus (OLP). STUDY DESIGN Blood, OLP lesion, and control samples were collected. Four DC subsets (CD11c+CD123-myeloid DC1 [mDC1], CD141+mDC2, CD11c-CD123+plasmacytoid DC [pDC], and CD1a+CD207+Langerhans cells [LC]) were investigated via flow cytometry (FCM) and immunohistochemical staining. Expression patterns of TLRs and their downstream molecules were analyzed via quantitative real-time polymerase chain reaction and immunohistochemistry in situ. RESULTS Thirty-two samples were collected (9 controls and 23 OLP patients). FCM results found that the percentages of LC, mDC1, mDC2, and pDC in situ were 0.0119 ± 0.0251%, 0.0064 ± 0.0134%, 0.0005 ± 0.0011%, and 0.0022 ± 0.0019% in control mucosa, respectively. The mDC1 (0.0300 ± 0.0276%) and pDC (0.0204 ± 0.0186%) subsets were significantly increased in OLP lesions (P < .01). No marked differences were evident, when comparing all 4 DC subsets from blood, between control and OLP groups. Significant upregulation of TLR7, TLR8, and TLR9 were disclosed in OLP (P < .01), along with their downstream interferon-α (IFN-α) signaling molecules (IRF7 and IFN-α, P < .01). CONCLUSION Our findings of increased infiltration of pDC and mDC1, along with upregulation of TLR/IFN-α signaling, provide valuable information for further understanding the immunity in OLP.
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Affiliation(s)
- Yufeng Wang
- Department of Oral Mucosal Diseases, Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China
| | - Shu Shang
- Shanghai University of Medicine and Health Science, Shanghai, China
| | - Qianqian Sun
- Department of Oral Mucosal Diseases, Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China
| | - Junjun Chen
- Department of Oral Mucosal Diseases, Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China
| | - Guanhuan Du
- Department of Oral Mucosal Diseases, Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China
| | - Hong Nie
- Shanghai Institute of Immunology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaozhe Han
- The Forsyth Institute, Department of Immunology and Infectious Diseases, Cambridge, MA, USA; Harvard School of Dental Medicine, Department of Oral Medicine, Infection and Immunity, Boston, MA, USA
| | - Guoyao Tang
- Department of Oral Mucosal Diseases, Ninth People's Hospital, College of Stomatology, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; National Clinical Research Center of Stomatology, Shanghai, China.
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Assessment of systemic inflammation with neutrophil-lymphocyte ratio in lichen planus. Postepy Dermatol Alergol 2016; 33:188-92. [PMID: 27512353 PMCID: PMC4969409 DOI: 10.5114/pdia.2016.56930] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/20/2015] [Indexed: 01/20/2023] Open
Abstract
Introduction Lichen planus (LP) is a papulosquamous eruption of the skin and mucous membranes. Although the exact pathogenesis of the disease remains unclear, it is believed that LP represents an inflammatory disorder. Neutrophil-lymphocyte (N/L) ratio is considered a systemic inflammatory marker that correlated with severity of the diseases. Aim To investigate whether N/L ratio increases in LP and may be an independent severity marker for LP lesions. Material and methods White blood cell (WBC), neutrophil and lymphocyte counts, N/L ratio, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were statistically compared between the patient (n = 55) and the control group (n = 48). The relationship of N/L ratio and the body surface area (BSA) was assessed. Results Erythrocyte sedimentation rate and CRP were statistically higher in patients with LP than in controls (p < 0.0001). Our analysis revealed a significantly higher level of N/L ratio in patients with LP compared with controls, respectively (2.5 ±1.1 (1.2–7.3) vs. 1.4 ±0.4 (0.8–2.7), p < 0.0001). Body surface area (p = 0.001), CRP (p = 0.006), and ESR (p = 0.003) were identified as possible predictors of N/L ratio, but only BSA (p = 0.002) and ESR (p = 0.003) were found as significant independent predictors in a multiple linear regression model. Conclusions The inflammatory process in LP was supported by our results. N/L ratio may have an impact to show the inflammatory status in patients with LP as an inexpensive, simple and effective predictor. It may be used for the severity and treatment option of LP. But, N/L ratio and LP relationship could be confirmed by other large prospective studies.
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Lee HJ, Kim KC, Han JA, Choi SS, Jung YJ. The early induction of suppressor of cytokine signaling 1 and the downregulation of toll-like receptors 7 and 9 induce tolerance in costimulated macrophages. Mol Cells 2015; 38:26-32. [PMID: 25518931 PMCID: PMC4314129 DOI: 10.14348/molcells.2015.2136] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/29/2014] [Accepted: 10/21/2014] [Indexed: 01/08/2023] Open
Abstract
Toll-like receptors (TLR) 7 and 9 transduce a cellular signal through the MyD88-dependent pathway and induce the production of inflammatory mediators against microbial nucleotide components. The repeated stimulation of TLR4 leads to endotoxin tolerance, but the molecular mechanisms of tolerance induced through the costimulation of individual TLR has not yet been established, although endosomal TLRs share signaling pathways with TLR4. In the present study, mouse macrophages were simultaneously stimulated with the TLR7 agonist, gardiquimod (GDQ), and the TLR9 agonist, CpG ODN 1826, to examine the mechanism and effector functions of macrophage tolerance. Compared with individual stimulation, the costimulation of both TLRs reduced the secretion of TNF-α and IL-6 through the delayed activation of the NF-κB pathway; notably, IL-10 remained unchanged in costimulated macrophages. This tolerance reflected the early induction of suppressor of cytokine signaling-1 (SOCS-1), according to the detection of elevated TNF-α secretion and restored NF-κB signaling in response to the siRNA-mediated abrogation of SOCS-1 signaling. In addition, the restimulation of each TLRs using the same ligand significantly reduced the expression of both TLRs in endosomes. These findings revealed that the costimulation of TLR7 and TLR9 induced macrophage tolerance via SOCS-1, and the restimulation of each receptor or both TLR7 and TLR9 downregulated TLR expression through a negative feedback mechanisms that protects the host from excessive inflammatory responses. Moreover, the insufficient and impaired immune response in chronic viral infection might also reflect the repeated and simultaneous stimulation of those endosomal TLRs.
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Affiliation(s)
- Hyo-Ji Lee
- BIT Medical Convergence Graduate Program, Kangwon National University, Chuncheon 200-701,
Korea
- Department of Biological Sciences, Kangwon National University, Chuncheon 200-701,
Korea
| | - Keun-Cheol Kim
- Department of Biological Sciences, Kangwon National University, Chuncheon 200-701,
Korea
| | - Jeong A Han
- Department of Biochemistry and Molecular Biology, School of Medicine, Kangwon National University, Chuncheon 200-701,
Korea
| | - Sun Shim Choi
- Department of Medical Biotechnology, Kangwon National University, Chuncheon 200-701,
Korea
| | - Yu-Jin Jung
- BIT Medical Convergence Graduate Program, Kangwon National University, Chuncheon 200-701,
Korea
- Department of Biological Sciences, Kangwon National University, Chuncheon 200-701,
Korea
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Domingues R, de Carvalho GC, da Silva Oliveira L, Futata Taniguchi E, Zimbres J, Aoki V, da Silva Duarte A, Sato M. The dysfunctional innate immune response triggered by Toll-like receptor activation is restored by TLR7/TLR8 and TLR9 ligands in cutaneous lichen planus. Br J Dermatol 2014; 172:48-55. [DOI: 10.1111/bjd.13214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 12/30/2022]
Affiliation(s)
- R. Domingues
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
| | - G. Costa de Carvalho
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
| | - L.M. da Silva Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
| | - E. Futata Taniguchi
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
| | - J.M. Zimbres
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
| | - V. Aoki
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
| | - A.J. da Silva Duarte
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
| | - M.N. Sato
- Laboratory of Dermatology and Immunodeficiencies, LIM-56; Department of Dermatology; Medical School of the University of São Paulo; Av. Dr. Enéas de Carvalho Aguiar 500, 3rd floor 05403-000 São Paulo Brazil
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