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Droździk A, Droździk M. Drug-Induced Gingival Overgrowth—Molecular Aspects of Drug Actions. Int J Mol Sci 2023; 24:ijms24065448. [PMID: 36982523 PMCID: PMC10052148 DOI: 10.3390/ijms24065448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Drug-induced gingival overgrowth (DIGO) is one of the side effects produced by therapeutic agents, most commonly phenytoin, nifedipine and cyclosporin A. However, the precise mechanism of DIGO is not entirely understood. A literature search of the MEDLINE/PubMed databases was conducted to identify the mechanisms involved in DIGO. The available information suggests that the pathogenesis of DIGO is multifactorial, but common pathogenic sequelae of events emerge, i.e., sodium and calcium channel antagonism or disturbed intracellular handling of calcium, which finally lead to reductions in intracellular folic acid levels. Disturbed cellular functions, mainly in keratinocytes and fibroblasts, result in increased collagen and glycosaminoglycans accumulation in the extracellular matrix. Dysregulation of collagenase activity, as well as integrins and membrane receptors, are key mechanisms of reduced degradation or excessive synthesis of connective tissue components. This manuscript describes the cellular and molecular factors involved in the epithelial–mesenchymal transition and extracellular matrix remodeling triggered by agents producing DIGO.
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Affiliation(s)
- Agnieszka Droździk
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72, 70-111 Szczecin, Poland
| | - Marek Droździk
- Department of Pharmacology, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72, 70-111 Szczecin, Poland
- Correspondence:
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Yi K, Li Q, Lian X, Wang Y, Tang Z. Utilizing 3D bioprinted platelet-rich fibrin-based materials to promote the regeneration of oral soft tissue. Regen Biomater 2022; 9:rbac021. [PMID: 35558097 PMCID: PMC9086746 DOI: 10.1093/rb/rbac021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/02/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
Oral soft tissue defects remain difficult to treat owing to the limited efficacy of available treatment materials. Although the injectable platelet-rich fibrin (i-PRF) is a safe, autologous source of high levels of growth factors that is often employed to promote the regeneration of oral soft tissue, its effectiveness is restrained by difficulties in intraoperative shaping together with the burst-like release of growth factors. We herein sought to develop a bioactive bioink composed of i-PRF, alginate and gelatin capable of promoting the regeneration of the oral soft tissue. This bioink was successfully applied in 3D bioprinting and exhibited its ability to be shaped to individual patient needs. Importantly, we were also able to significantly prolong the duration of multiple growth factors release as compared to that observed for i-PRF. The growth factor bioavailability was further confirmed by the enhanced proliferation and viability of printed gingival fibroblasts. When deployed in vivo in nude mice, this bioink was further confirmed to be biocompatible and to drive enhanced angiogenic activity. Together, these data thus confirm the successful production of an i-PRF-containing bioink, which is suitable for the individualized promotion of the regeneration of oral soft tissue.
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Affiliation(s)
- Ke Yi
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, 100101, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
| | - Qing Li
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, 100101, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
| | - Xiaodong Lian
- Department of Chemistry, Renmin University of China, Beijing, 100872, China
| | - Yapei Wang
- Department of Chemistry, Renmin University of China, Beijing, 100872, China
| | - Zhihui Tang
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, 100101, China
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Smith PC, Metz C, de la Peña A, Oyanadel C, Avila P, Arancibia R, Vicuña L, Retamal C, Barake F, González A, Soza A. Galectin-8 mediates fibrogenesis induced by cyclosporine in human gingival fibroblasts. J Periodontal Res 2020; 55:724-733. [PMID: 32449990 DOI: 10.1111/jre.12761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE During cyclosporine-induced gingival overgrowth, the homeostatic balance of gingival connective tissue is disrupted leading to fibrosis. Galectins are glycan-binding proteins that can modulate a variety of cellular processes including fibrosis in several organs. Here, we study the role of galectin-8 (Gal-8) in the response of gingival connective tissue cells to cyclosporine. METHODS We used human gingival fibroblasts and mouse NIH3T3 cells treated with recombinant Gal-8 and/or cyclosporine for analyzing specific mRNA and protein levels through immunoblot, real-time polymerase chain reaction, ELISA and immunofluorescence, pull-down with Gal-8-Sepharose for Gal-8-to-cell surface glycoprotein interactions, short hairpin RNA for Gal-8 silencing and Student's t test and ANOVA for statistical analysis. RESULTS Galectin-8 stimulated type I collagen and fibronectin protein levels and potentiated CTGF protein levels in TGF-β1-stimulated human gingival fibroblasts. Gal-8 interacted with α5β1-integrin and type II TGF-β receptor. Gal-8 stimulated fibronectin protein and mRNA levels, and this response was dependent on FAK activity but not Smad2/3 signaling. Cyclosporine and tumor necrosis factor alpha (TNF-α) increased Gal-8 protein levels. Finally, silencing of galectin-8 in NIH3T3 cells abolished cyclosporine-induced fibronectin protein levels. CONCLUSION Taken together, these results reveal for the first time Gal-8 as a fibrogenic stimulus exerted through β1-integrin/FAK pathways in human gingival fibroblasts, which can be triggered by cyclosporine. Further studies should explore the involvement of Gal-8 in human gingival tissues and its role in drug-induced gingival overgrowth.
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Affiliation(s)
- Patricio C Smith
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Metz
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Adely de la Peña
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Claudia Oyanadel
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Patricio Avila
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Arancibia
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lucas Vicuña
- Department of Statistics, Faculty of Mathematics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Retamal
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Francisca Barake
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile.,Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso González
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile.,Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Soza
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile.,Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
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Abstract
Gingival overgrowth occurs mainly as a result of certain anti-seizure, immunosuppressive, or antihypertensive drug therapies. Excess gingival tissues impede oral function and are disfiguring. Effective oral hygiene is compromised in the presence of gingival overgrowth, and it is now recognized that this may have negative implications for the systemic health of affected patients. Recent studies indicate that cytokine balances are abnormal in drug-induced forms of gingival overgrowth. Data supporting molecular and cellular characteristics that distinguish different forms of gingival overgrowth are summarized, and aspects of gingival fibroblast extracellular matrix metabolism that are unique to gingival tissues and cells are reviewed. Abnormal cytokine balances derived principally from lymphocytes and macrophages, and unique aspects of gingival extracellular matrix metabolism, are elements of a working model presented to facilitate our gaining a better understanding of mechanisms and of the tissue specificity of gingival overgrowth.
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Affiliation(s)
- P C Trackman
- Boston University Goldman School of Dental Medicine, Department of Periodontology and Oral Biology, Division of Oral Biology, Boston, MA 02118, USA.
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Abstract
Gingival overgrowth is a common adverse effect of therapy with Phenytoin, having important medical and cosmetic implications. Poor periodontal hygiene is an important risk factor for severity of Phenytoin-induced gingival overgrowth (PIGO), which is a time-dependent process. There is complex interplay of altered fibroblast biology, connective tissue turnover, inflammatory processes, and growth factors on a background of genetic susceptibility to produce increase in various components of interstitial matrix in PIGO tissue. Treatment options have included change of PHT to another anti-seizure drug, measures to improve periodontal hygiene and gingivectomy. There is conclusive evidence that folic acid supplementation significantly decreases the incidence of PIGO.
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Affiliation(s)
- R Arya
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Rawal SY, Dabbous MK, Tipton DA. Effect of cannabidiol on human gingival fibroblast extracellular matrix metabolism: MMP production and activity, and production of fibronectin and transforming growth factor β. J Periodontal Res 2011; 47:320-9. [PMID: 22092062 DOI: 10.1111/j.1600-0765.2011.01435.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Marijuana (Cannabis sativa) use may be associated with gingival enlargement, resembling that caused by phenytoin. Cannabidiol (CBD), a nonpsychotropic Cannabis derivative, is structurally similar to phenytoin. While there are many reports on effects of phenytoin on human gingival fibroblasts, there is no information on effects of Cannabis components on these cells. The objective of this study was to determine effects of CBD on human gingival fibroblast fibrogenic and matrix-degrading activities. MATERIAL AND METHODS Fibroblasts were incubated with CBD in serum-free medium for 1-6 d. The effect of CBD on cell viability was determined by measuring activity of a mitochondrial enzyme. The fibrogenic molecule transforming growth factor β and the extracellular matrix molecule fibronectin were measured by ELISA. Pro-MMP-1 and total MMP-2 were measured by ELISA. Activity of MMP-2 was determined via a colorimetric assay in which a detection enzyme is activated by active MMP-2. Data were analysed using ANOVA and Scheffe's F procedure for post hoc comparisons. RESULTS Cannabidiol had little or no significant effect on cell viability. Low CBD concentrations increased transforming growth factor β production by as much as 40% (p < 0.001), while higher concentrations decreased it by as much as 40% (p < 0.0001). Cannabidiol increased fibronectin production by as much as approximately 100% (p < 0.001). Lower CBD concentrations increased MMP production, but the highest concentrations decreased production of both MMPs (p < 0.05) and decreased MMP-2 activity (p < 0.02). CONCLUSION The data suggest that the CBD may promote fibrotic gingival enlargement by increasing gingival fibroblast production of transforming growth factor β and fibronectin, while decreasing MMP production and activity.
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Affiliation(s)
- S Y Rawal
- College of Dentistry, Department of Periodontology, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Sobral LM, Aseredo F, Agostini M, Bufalino A, Pereira MCC, Graner E, Coletta RD. Molecular events associated with ciclosporin A-induced gingival overgrowth are attenuated by Smad7 overexpression in fibroblasts. J Periodontal Res 2011; 47:149-58. [DOI: 10.1111/j.1600-0765.2011.01412.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Uzel MI, Kantarci A, Hong HH, Uygur C, Sheff MC, Firatli E, Trackman PC. Connective tissue growth factor in drug-induced gingival overgrowth. J Periodontol 2001; 72:921-31. [PMID: 11495141 DOI: 10.1902/jop.2001.72.7.921] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Drug-induced gingival overgrowth is a known side effect of certain chemotherapeutic agents used for the treatment of systemic disorders. The pathogenesis and mechanisms responsible for this condition are not fully understood. This study assesses for the presence and localization of connective tissue growth factor (CTGF) in drug-induced gingival overgrowth tissues. CTGF immunostaining was compared with sections stained with transforming growth factor (TGF)-beta1 and CD31 antibodies in order to investigate possible pathogenic mechanisms. METHODS Gingival overgrowth samples were obtained from patients undergoing therapy with phenytoin (n = 9), nifedipine (n = 4), cyclosporin A (n = 5), and control tissues from systemically healthy donors (n = 9). Tissue sections were subjected to peroxidase immunohistochemistry and were stained with CTGF and TGF-beta1 polyclonal primary antibodies. Possible relationships between CTGF staining and angiogenesis were also studied using an anti-CD31 antibody as a marker for endothelial cells. Staining was analyzed by computer-assisted quantitative and semiquantitative methodology at 5 defined sites in all samples based on the location of specific landmarks including epithelium and underlying connective tissues. RESULTS Cellular and extracellular CTGF content in phenytoin gingival overgrowth tissues was significantly (P<0.05) higher compared to the other gingival overgrowth tissues and the controls. Higher CTGF staining in phenytoin gingival overgrowth tissues was accompanied by an increased abundance of fibroblasts and connective tissue fibers. No strong association of CTGF staining with TGF-beta1 or CD31 staining was found. CONCLUSIONS The data from the present study show significantly higher CTGF staining in phenytoin-induced gingival overgrowth tissues compared to controls, cyclosporin A-, or nifedipine-induced gingival overgrowth. Moreover, semiquantitative analyses of histologic samples support the concept that the phenytoin overgrowth tissues are fibrotic. These associations suggest a possible role for CTGF in promoting development of fibrotic lesions in phenytoin-induced gingival overgrowth.
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Affiliation(s)
- M I Uzel
- Department of Periodontology and Oral Biology, Boston University, Goldman School of Dental Medicine, MA 02118, USA
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Harel-Raviv M, Eckler M, Lalani K, Raviv E, Gornitsky M. Nifedipine-induced gingival hyperplasia. A comprehensive review and analysis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 79:715-22. [PMID: 7621029 DOI: 10.1016/s1079-2104(05)80306-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A comprehensive review of the literature and analysis of the clinical history, mechanisms, pathogenesis, histology, and management of nifedipine-induced gingival hyperplasia is reported. A correlation to age, gender, drug, dosage, duration of drug therapy, location, and mode of treatment is discussed. The case report presented provides a model for management of nifedipine-induced gingival hyperplasia and other drug-induced gingival hyperplasia.
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Affiliation(s)
- M Harel-Raviv
- Department Preventive and Community Dentistry, Faculty of Dentistry, McGill University, Quebec, Canada
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Abstract
INTRODUCTION-The aim of this case report is to present a 15-year follow-up of a patient with phenytoin (PHT) intoxication with unilateral gingival hyperplasia (GH). MATERIAL AND METHODS-A 50-year-old woman was followed-up for 15 years clinically and paraclinically after a heavy PHT intoxication. Her immunoglobulins in serum were checked on PHT and after 15 years treatment with carbamazepine. RESULTS-A gross mass of hyperplasia tissue found primarily in the left side of her mouth had disappeared and serum IgA which was subnormal at the first visit had normalized. CONCLUSION-It is possible to prevent GH from PHT treatment by intensive dental care, correct mouth hygiene and by change of treatment of carbamazepine.
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Affiliation(s)
- S Tigaran
- Neurology Clinic, Hvidovre Hospital, Copenhagen, Denmark
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High AS, Robinson PA. Differences in adhesion and collagen gel contraction between fibroblasts from various types of odontogenic cyst. Arch Oral Biol 1994; 39:387-93. [PMID: 8060261 DOI: 10.1016/0003-9969(94)90168-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fibroblasts were grown from explants of normal gingiva and foreskin, and from walls of dentigerous, radicular and residual cysts, as well as keratocysts of basal-cell naevus syndrome and non-syndrome origin. Dentigerous-cyst fibroblast adhesion to poly-L-lysine-coated glass was unaffected by all adhesion-related glycoproteins. Chondroitin sulphate, fibronectin and heparan sulphate enhanced attachment of all other fibroblasts. Chondroitin-sulphate and fibronectin-enhanced adhesion was blocked by an arg-gly-asp peptide. Fibronectin, chondroitin sulphate and laminin all promoted collagen lattice contraction using normal gingival fibroblasts and low-serum media. Fibronectin had a greater effect than chondroitin sulphate and laminin. In media with standard serum, all cyst fibroblast lines examined demonstrated similar gel contraction curves with the exception of dentigerous cyst-derived fibroblasts, which contracted at decreased rates. Suppression of gel contraction was seen with dentigerous-cyst fibroblasts with all extracellular matrix glycoproteins and low serum. Dentigerous-cyst fibroblast attachment to glass and behaviour in gel lattices suggest that these cells express different functional attachment factors from other cyst fibroblast types.
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Affiliation(s)
- A S High
- Division of Dental Surgery, Leeds Dental Institute, U.K
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