Molecular Aspects of Drug-Induced Gingival Overgrowth: An In Vitro Study on Amlodipine and Gingival Fibroblasts

Analysis of the basement membrane-related genes ITGA7 and its regulatory role in periodontitis via machine learning: a retrospective study

BACKGROUND

Periodontitis is among the most prevalent inflammatory conditions and greatly impacts oral health. This study aimed to elucidate the role of basement membrane-related genes in the pathogenesis and diagnosis of periodontitis.

METHODS

GSE10334 was used for identification of hub genes via the differential analysis, protein-protein interaction network, MCC and DMNC algorithms, and evaluation via LASSO regression and support vector machine analysis to identify basement membrane-related markers in patients with periodontitis. Findings were validated by analysis of the GSE16134 dataset and quantitative reverse transcription PCR. The regulatory interplay among lncRNAs, miRNAs, and mRNAs was investigated through multiple databases. Immune infiltration analysis was performed to assess the immune landscape in periodontitis.

RESULTS

ITGA7 was identified as a key gene for periodontitis, as supported by machine learning analysis, validation of expression, and receiver operating characteristic analysis from external datasets. Immune infiltration analysis revealed significant associations between ITGA7 expression and the infiltration of numerous immune cells implicated in periodontitis. Additionally, our findings suggest that the expression of the lncRNA LINC-PINT is significantly increased in periodontitis, and that it can modulate ITGA7 expression through hsa-miR-1293.

CONCLUSION

ITGA7 is a potential diagnostic and therapeutic target for periodontitis. The LINC-PINT/hsa-miR-1293/ITGA7 axis and the relationship between ITGA7 and immune infiltration provide new insights into the molecular mechanisms underlying periodontitis and highlight potential avenues for clinical intervention.

Amlodipine-induced gingival hyperplasia in a Nepalese patient experiencing high dosages: a case report

Introduction and importance

Amlodipine is a third-generation calcium channel blocker used in the treatment of hypertension. One of the side effects associated with amlodipine is gingival hyperplasia mostly occurring at a higher dose (10 mg). There are very few cases of gingival hyperplasia associated with amlodipine at a lower dose (5 mg) or short-term administration.

Case presentation

A 51-year-old male patient with diagnosed hypertension sought medical attention for gingival swelling and bleeding from the gums while brushing. He had been under amlodipine 5 mg for 12 months, which was increased to 10 mg for the last 2 months. The history and physical examination were consistent with amlodipine-induced gingival hyperplasia. The first line of treatment consisted of discontinuation of amlodipine and substitution with another class of anti-hypertensive.

Clinical discussion and conclusion

The presented case highlights the challenge of balancing economic considerations with potential side effects in the use of amlodipine for hypertension in low-income countries like Nepal. Given its availability at no cost or minimal expense, amlodipine is often initiated as a first-line therapy. However, the decision to increase the dosage to 10 mg/day, influenced by economic constraints and the drug's affordability, raises the risk of gingival hyperplasia. This case emphasizes the importance of physicians being mindful of potential adverse effects when prescribing higher doses of amlodipine and underscores the need for continued vigilance in managing hypertension in resource-limited settings.

Amlodipine-Induced Gingival Hypertrophy: A Case Report

Gingival hypertrophy caused by certain drugs, including amlodipine, may occur in genetically susceptible individuals. There is no clear explanation for the exact mechanism behind gingival hypertrophy, but a multifactorial theory has been proposed that unifies the phenomenon. In addition to causing difficulty with speech and mastication, gingival hypertrophy also contributes to poor oral hygiene and unaesthetic appearance. We describe the case of a 54-year-old woman who developed gingival hypertrophy due to the long-standing antihypertensive medication amlodipine 5 mg taken twice daily for four years.

M, Kumar SP, Krishnan M. A Rare Case of Hormone-Induced Plasma Cell Granuloma of the Gingiva

Plasma cell granuloma (PCG), also known as inflammatory pseudotumor, is of unknown etiopathogenesis. It commonly presents in the lungs and can also occur in the liver, kidney, brain, and heart. PCG is rare in the oral cavity and even rarer in the gingiva. The clinical and radiological presentation of this disease in the oral cavity appears to be aggressive in nature and is often misdiagnosed as a malignant lesion. Histopathology helps in distinguishing PCG of gingiva from other benign and malignant lesions of the gingiva. Amlodipine and cyclosporine-induced PCG of gingiva have been reported in the literature. This report presents a rare case of generalized plasma cell granuloma of the gingiva in an adult female patient who was on hormonal therapy for infertility. Treatment consisted of complete surgical excision of the lesion and extraction of teeth with a poor prognosis. Wound healing was uneventful during the one-year follow-up period with no signs of recurrence.

Associations of toothbrushing behaviour with risks of vascular and nonvascular diseases in Chinese adults

Accumulating evidence has shown that poor oral hygiene is associated with increased risk of cardiometabolic diseases in Western populations. However, its relevance about the relationships in Chinese adults remains unclear. The China Kadoorie Biobank enrolled 512 715 adults aged 30-79 years in China during 2004-2008. Cox regression was used to estimate adjusted hazard ratios (HRs) for each disease associated with measures of oral hygiene. Overall 9.3% of the participants reported rarely or never brushing teeth at baseline. Participants who rarely or never brushed teeth had adjusted HR of 1.12 (95% CI: 1.09, 1.15) for MVE, with similar HRs for stroke (1.08, 1.05-1.12), intracerebral haemorrhage (1.18, 1.11-1.26) and pulmonary heart disease (1.22, 1.13-1.32) compared with those who brushed teeth regularly. Those who did not brush teeth also had increased risk of cancer (1.09, 1.04-1.14), chronic obstructive pulmonary disease (COPD) (1.12, 1.05-1.20), liver cirrhosis (1.25, 1.09-1.44) and all-cause death (1.25, 1.21-1.28) but not type 2 diabetes (0.94, 0.86-1.03) and chronic kidney disease (0.98, 0.81-1.18). Among Chinese adults, we found that poor oral hygiene is associated with higher risks of major vascular disease, cancer, COPD, liver cirrhosis and all-cause deaths, but not type 2 diabetes and chronic kidney disease.

Oral Mucosa Status and Saliva Parameters of Multimorbid Adult Patients Diagnosed with End-Stage Chronic Kidney Disease

There has been an increasing number of patients diagnosed with chronic diseases. Many of those diseases determine changes in patients’ social and even professional life. The aim of the present work was to analyze saliva and oral mucosa parameters in adult patients diagnosed with chronic diseases. A total of 228 patients took part in the research. A total of 180 patients were hemodialyzed in Diaverum dialysis stations, and there were 48 patients from the Conservative Dentistry with Endodontics Clinic of the Academic Centre of Dentistry of Silesian Medical University in Bytom and patients from the dentistry division of the Arnika Clinic in Zabrze not diagnosed with any such diseases. Selected saliva parameters (secretion, pH and buffer capacity) and mucosa status were examined. In order to obtain information regarding xerostomia, patients were given a questionnaire. Patients assigned to the control group rarely used water to make swallowing easier or used candies to lessen the feeling of oral cavity dryness. They also rarely suffered from eye dryness. The feeling of dryness also did not influence their social life. The amount of produced saliva was higher in the control group. There was a significantly lower percentage of patients with a low buffer capacity of saliva. There were no differences in terms of saliva pH values between the two groups of patients. A significantly lower number of patients were diagnosed with ecchymosis, candidiasis, scrotal tongue and mechanical damages. Patients diagnosed with chronic diseases need to be provided with long-term care.

Biology of Drug-Induced Gingival Hyperplasia: In Vitro Study of the Effect of Nifedipine on Human Fibroblasts

Background: It has been proven that the antihypertensive agent nifedipine can cause gingival overgrowth as a side effect. The aim of this study was to analyze the effects of pharmacological treatment with nifedipine on human gingival fibroblasts activity, investigating the possible pathogenetic mechanisms that lead to the onset of gingival enlargement. Methods: The expression profile of 57 genes belonging to the “Extracellular Matrix and Adhesion Molecules” pathway, fibroblasts’ viability at different drug concentrations, and E-cadherin levels in treated fibroblasts were assessed using real-time Polymerase Chain Reaction, PrestoBlue™ cell viability test, and an enzyme-linked immunoassay (ELISA), respectively. Results: Metalloproteinase 24 and 8 (MMP24, MMP8) showed significant upregulation in treated cells with respect to the control group, and cell adhesion gene CDH1 (E-cadherin) levels were recorded as increased in treated fibroblasts using both real-time PCR and ELISA. Downregulation was observed for transmembrane receptors ITGA6 and ITGB4, the basement membrane constituent LAMA1 and LAMB1, and the extracellular matrix protease MMP11, MMP16, and MMP26. Conclusions: The obtained data suggested that the pathogenesis of nifedipine-induced gingival overgrowth is characterized by an excessive accumulation of collagen due to the inhibition of collagen intracellular and extracellular degradation pathways.