Bcl-2 expression and its possible influence on malignant transformation of oral lichen planus

PURPOSE

The aim of this study was to investigate the malignant potential of oral lichen planus (OLP) on the basis of the expression of the Bcl-2 marker in healthy individuals (H), patients with OLP and patients with squamous cell carcinoma (SCC), and to establish potential interdependence between expression of Bcl-2 and the different clinical and histopathological parameters in H, OLP, and SCC.

METHODS

Immunohistochemistry for Bcl-2 was carried out using an avidin-biotin peroxidase complex method. Tissue sections were treated with mouse monoclonal antibody against Bcl-2 (124, DAKO A/S, Denmark; dilution 1/100). Immunohistochemical parameters measured included total tissue area, total stained area and intensity of stain.

RESULTS

Keratinocytes were not Bcl-2 positive in H and were sparsely positive in OLP. The number of lymphocytes stained with Bcl-2 was significantly lower in H as compared to patients with SCC and OLP. Bcl-2 staining was weak to moderate in OLP, and moderate to intense in SCC. Bcl-2-positive lymphocytes were more expressed in older OLP patients (>55 years), and in OLP specimens with orthokeratinized epithelium, less developed acanthosis and highest grade of lymphocyte expression.

CONCLUSION

Bcl-2 may not serve as a prognostic biomarker in oral cancer development from OLP, but it could help in selecting patients with higher need of follow up to prevent malignancy.

Expression of Fas/FasL in patients with oral lichen planus

PURPOSE

To investigate the malignant potential of oral lichen planus (OLP) on the basis of expression of the Fas/FasL markers in healthy individuals (H), OLP patients and patients with squamous cell carcinoma (SCC).

PATIENTS AND METHODS

40 patients with OLP and two control groups were included in this research (H and patients with SCC). Immunohistochemistry for Fas and FasL was carried out using an avidin-biotin peroxidase complex method.

RESULTS

Only a low percentage of infiltrating lymphocytes and no keratinocytes were Fas-positive in OLP specimens. The highest percentage of Fas-staining keratinocytes in our survey was identified mostly in H and patients with well-differentiated SCC. In most cases of SCC, OLP and H a high percentage of keratinocytes and lymphocytes were FasL-positive. FasL expression was negatively correlated with the degree of cell differentiation and apoptosis. Taking into consideration that all carcinomas in this survey were highly differentiated, it is not surprising that no statistically significant differences in FasL expression between H, OLP and SCC specimens were detected.

CONCLUSION

Downregulation of Fas expression in keratinocytes and lymphocytes of OLP specimens, together with upregulation of FasL, may serve as initial prognostic biomarker in oral cancer development.

Update on mucous membrane pemphigoid: a heterogeneous immune-mediated subepithelial blistering entity

Most oral involvement in the skin diseases (dermatoses) is related to mucous membrane pemphigoid or lichen planus. Mucous membrane pemphigoid was the subject of a European Symposium held in Turin, Italy, in June 1997. This review is based on that symposium. Mucous membrane pemphigoid is a subepithelial vesiculobullous disorder mainly of late middle age; it has a slight predilection for women. Whereas mucous membrane pemphigoid was formerly considered a single entity, it is now quite evident that a number of subepithelial vesiculobullous disorders may produce similar clinical pictures and also that a range of variants of mucous membrane pemphigoid exists, with antibodies directed against various hemidesmosomal components or components of the epithelial basement membrane. The term immune-mediated subepithelial blistering diseases has therefore been used. Diagnosis and management of immune-mediated subepithelial blistering diseases on clinical grounds alone are impossible; a full history, general and oral examinations, and biopsy with immunostaining are now invariably required, sometimes supplemented with other investigations. Most patients with mucous membrane pemphigoid affecting the mouth manifest desquamative gingivitis, a fairly common complaint typically seen in women who are middle-aged or older. Oral vesicles and erosions may also occur, and there can be a positive Nikolsky sign. Some patients have lesions of other stratified squamous epithelia, presenting as conjunctival, nasal, oesophageal, laryngeal, vulval, penile, or anal involvement. Apart from improving oral hygiene, immunomodulatory-in particular, immunosuppressive-therapy is typically required to control oral lesions in mucous membrane pemphigoid. No single treatment regimen reliably controls all these disorders.

[Buccal dryness, xerostomia and measurement of salivary secretory activity]

Xerostomia is a marked reduction in saliva production and may occur as an early symptom of various systemic diseases. It is also secondary to the administration of numerous drugs. Severity of salivary gland dysfunction cannot be predicted from subjective reports of oral dryness by patient, and accurate assessments of salivary gland function should be managed. Several procedures for saliva samplings and secretory activity measurements have been reported. In normal individuals, the mean values of unstimulated whole saliva was slightly higher in males (0.42 ml/min) than in females (0.37 ml/min). Corresponding mean values for stimulated whole saliva are 1.77 ml/min and 1.38 ml/min. Unstimulated whole saliva collection during 15 min is recommended as the most reliable test for clinical diagnosis. It is found that an unstimulated salivary flow of 0.1 ml/min represents the cut-off limit for the diagnosis of xerostomia.

Biochemical and pharmacological properties of a neurotoxic protein isolated from the blood serum of heavily burned patients

Blood serum of heavily burned patients contains neurotoxic substances which are not present in normal control sera. In the present paper, we describe the purification by gel filtration and ultracentrifugation of such a neurotoxic factor. The purified factor appeared to be a high molecular weight (2 to 3.10(6) daltons) lipoprotein. This factor was present in all the sera of patients with more than 35 per cent of the body surface burned. When injected into rabbits the lipoprotein caused a flattening of the EEG tracing, then trembling and convulsions with bursts of spikes on the EEG. The activity of this neurotoxic substance was enhanced when the permeability of the blood-brain barrier was increased by previous intraventricular injection of collagenase. The presence of such a neurotoxic factor in the blood serum of burned patients, together with the increased serum collagenase activity they exhibit may explain the neurotoxic symptoms observed in them.

Biochemical and pharmacological properties of a cardiotoxic factor isolated from the blood serum of burned patients

Blood serum of severely burned patients contains several substances which are not present in normal sera. One of these substances, a small protein of an approximate molecular weight of 12 to 14,000 daltons displayed a toxic action on the circulatory system. This cardiotoxic factor was obtained in a purified form by alcohol precipitation followed by gel filtration and carboxymethyl cellulose chromatography. The purified preparation seems to be a low molecular weight protein of about 8000 daltons. The biological effects of this substance consist essentially of alterations of the ECG pattern, indicating decreased cardiac output and ischaemia of the cardial muscle. The blood pressure decreases and respiratory function is also altered. The presence of such a toxic factor in sufficient concentration in the blood serum may explain the cardiovascular complications observed in some burned patients.

Serum elastase and its inhibitors in the blood of heavily burnt patients

Serum elastase and its inhibitors were determined in the sera of heavily burnt patients. Serum elastase levels were elevated at two to eight days after a severe burn-accident and returned towards normal values from the 10th day on. Both alpha1-antitrypsin and alpha2-macroglobulin levels were also elevated in the sera of heavily burnt patients. alpha1-Antitrypsin showed a parallel evolution to the elastase level but alpha2-macroglobulin followed a somewhat different time curve. Plasminogen and antithrombin were not elevated significantly. It is suggested that serum elastase may play a role in tissue degradation in burnt patients.

[Demonstration and partial characterization of cardiotoxic and neutrotoxic substances in the serum of burnt patients (author's transl)]

Cardio-circulatory and neurological complications may appear between the second and seventh day of treatment of severely burnt (greater than 30% of body surface, 3rd degree) patients between the 2nd and 7th day, even if their lesions follow an apparently favorable course. The purpose of the present work was to isolate substances from the sera of such patients which would be responsible for the toxic effects. The sera of several patients were fractionated by Cohn's method n degree 6 and the fractions were tested in vivo in rabbits, rats and mice for their toxic effects. We could demonstrate in some of the fractions (II + III, IV and VI) toxic activity on the central nervous system, on the cardiocirculatory and respiratory systems. An acute toxic activity was also present as well as a substance increasing the permeability of the blood-brain barrier. All these factors together may be involved in the production of the above-mentioned clinical symptoms. Their appearance may depend on the concentration of toxic substances in the blood and on the resistance of the patients.

[Evolution of serum copper and zinc levels in burn patients (author's transl)]

The study of copper and zinc in 35 patients, over periods of up to 21 days following thermal injury, is marked by an important and early fall in serum copper and zinc levels. The maximum intensity of the biological disturbance appears about two days after the injury. Reversion to near normal values coincides with recovery from the large part of the lesions. The comparison of the evolution of serum levels does not permit any definite relationship to be established between copper and zinc metabolism.