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Reddy SSP, Manohar B. Histological and whole-genome sequencing analysis of coronally advanced flap with connective tissue graft for the treatment of gingival recession-A case study. Clin Adv Periodontics 2024; 14:192-200. [PMID: 37987219 DOI: 10.1002/cap.10273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Oral tissue morphogenesis is innately determined and genetically controlled by underlying connective tissue. The connective tissue graft (CTG) harvested from palatal donor sites originally retains "regional specificity" and is considered to be responsible for epithelial keratinization. METHODS This case study presents histological and genomic outcomes of coronally advanced flap (CAF) with CTG for the management of marginal tissue recession (MTR). The tissue samples harvested at 12-month postoperative period, during the debulking procedure of the treated site were subjected to Masson's trichrome staining (MTS) and whole-genome sequencing (WGS). RESULTS Clinically, the mean root coverage as compared to baseline at 6 months (90%), 12 months (95%), and 24 months (95%) postoperatively was achieved. Overbulking of treated site was evident even after 12 months. Nevertheless, clinically discernible alterations in epithelial keratinization were not present. Although MTS revealed areas of non-keratinization and para-keratinization, WGS revealed a significant expression of keratinization genes, neural crest, and positional marker genes. CONCLUSIONS CAF with CTG is still considered the "gold standard" in treatment of MTR. The keratinization of overlying epithelium at sites hitherto where non-keratinized mucosa is advanced over CTG may not be complete even after 12 months. It is evident from the analysis of the reported case that clinically such sites may appear non-keratinized despite the expression of genes for keratinization. The complex interplay between genomic and phenotypic expressions serves as a foundation of biological concepts. Nevertheless, it is imperative to acknowledge that the phenotype of an organism is not solely determined by genetic expression and is often influenced by a complex interaction between genetic background and environmental factors. KEY SUMMARY The connective tissue serves as a medium for transmitting the genetic code and exerting an influence on the properties of the overlying epithelial tissue. Concrete evidence implies connective tissue plays a significant role in influencing the keratinization process of the overlying epithelium. Epithelial keratinization following a coronally advanced flap with connective tissue graft is also governed by environmental factors in addition to inherent potential within the graft. Differences in gene expression profiles may vary from individuals, teeth and among sites.
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Affiliation(s)
- Saravanan Sampoornam Pape Reddy
- Department of Periodontology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, Odisha, India
- Department of Periodontology, Army Dental Centre (Research & Referral), Army Hospital (Research & Referral), New Delhi, India
| | - Balaji Manohar
- Department of Periodontology, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (Deemed to be University), Bhubaneswar, Odisha, India
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Lifshits LA, Breuer Y, Sova M, Gupta S, Kadosh D, Weinberg E, Hayouka Z, Bar DZ, Gal M. Nature-inspired peptide of MtDef4 C-terminus tail enables protein delivery in mammalian cells. Sci Rep 2024; 14:4604. [PMID: 38409451 PMCID: PMC10897151 DOI: 10.1038/s41598-024-55274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
Cell-penetrating peptides show promise as versatile tools for intracellular delivery of therapeutic agents. Various peptides have originated from natural proteins with antimicrobial activity. We investigated the mammalian cell-penetrating properties of a 16-residue peptide with the sequence GRCRGFRRRCFCTTHC from the C-terminus tail of the Medicago truncatula defensin MtDef4. We evaluated the peptide's ability to penetrate multiple cell types. Our results demonstrate that the peptide efficiently penetrates mammalian cells within minutes and at a micromolar concentration. Moreover, upon N-terminal fusion to the fluorescent protein GFP, the peptide efficiently delivers GFP into the cells. Despite its remarkable cellular permeability, the peptide has only a minor effect on cellular viability, making it a promising candidate for developing a cell-penetrating peptide with potential therapeutic applications.
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Affiliation(s)
- Lucia Adriana Lifshits
- Department of Oral Biology, Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Yoav Breuer
- Department of Oral Biology, Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Marina Sova
- Department of Oral Biology, Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Sumit Gupta
- BLAVATNIK CENTER for Drug Discovery, Tel-Aviv University, 6997801, Tel Aviv, Israel
| | - Dar Kadosh
- Department of Oral Biology, Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Evgeny Weinberg
- Department of Oral Biology, Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Zvi Hayouka
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agricultural, Food and Environment, The Hebrew University of Jerusalem, 76100, Rehovot, Israel
| | - Daniel Z Bar
- Department of Oral Biology, Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Maayan Gal
- Department of Oral Biology, Faculty of Medicine, The Goldschleger School of Dental Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
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Berg T, Doppelt-Flikshtain O, Coyac BR, Zigdon-Giladi H. Oral fibroblasts rescue osteogenic differentiation of mesenchymal stem cells after exposure to Zoledronic acid in a paracrine effect. Front Pharmacol 2023; 14:1172705. [PMID: 37637413 PMCID: PMC10450747 DOI: 10.3389/fphar.2023.1172705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Background: Medication-related osteonecrosis of the jaw is a serious complication that develops in oncologic patients treated with Zoledronic acid. Although used for over 30 years, the influence of Zoledronic acid on bone has been thoroughly investigated, mainly on osteoclasts. While decreasing osteoclast differentiation and function, for many years it was thought that Zoledronic acid increased osteoblast differentiation, thus increasing bone volume. Moreover, despite the influence of soft tissue on the bone healing process, the impact of zoledronic acid on the interaction between soft tissue and bone was not investigated. Aim: Our goal was to investigate the influence of Zoledronic Acid and soft tissue cells on osteogenic differentiation of mesenchymal stem cells (MSCs). Materials and methods: Osteogenic differentiation of MSCs was examined after exposure to Zoledronic Acid. To determine the influence of soft tissue cells on MSCs' osteogenic differentiation, conditioned media from keratinocytes and oral fibroblasts were added to osteogenic medium supplemented with Zoledronic Acid. Proteomic composition of keratinocytes' and fibroblasts' conditioned media were analyzed. Results: Zoledronic Acid decreased osteogenic differentiation of MSCs by seven-fold. The osteogenic differentiation of MSCs was restored by the supplementation of fibroblasts' conditioned medium to osteogenic medium, despite Zoledronic acid treatment. Five osteogenic proteins involved in the TGFβ pathway were exclusively identified in fibroblasts' conditioned medium, suggesting their role in the rescue effect. Conclusion: Oral fibroblasts secrete proteins that enable osteogenic differentiation of MSCs in the presence of Zoledronic Acid.
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Affiliation(s)
- Tal Berg
- Laboratory for Bone Repair, Rambam Healthcare Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofri Doppelt-Flikshtain
- Laboratory for Bone Repair, Rambam Healthcare Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Benjamin R. Coyac
- Laboratory for Bone Repair, Rambam Healthcare Campus, Haifa, Israel
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Hadar Zigdon-Giladi
- Laboratory for Bone Repair, Rambam Healthcare Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
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Wieder R. Fibroblasts as Turned Agents in Cancer Progression. Cancers (Basel) 2023; 15:2014. [PMID: 37046676 PMCID: PMC10093070 DOI: 10.3390/cancers15072014] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
Differentiated epithelial cells reside in the homeostatic microenvironment of the native organ stroma. The stroma supports their normal function, their G0 differentiated state, and their expansion/contraction through the various stages of the life cycle and physiologic functions of the host. When malignant transformation begins, the microenvironment tries to suppress and eliminate the transformed cells, while cancer cells, in turn, try to resist these suppressive efforts. The tumor microenvironment encompasses a large variety of cell types recruited by the tumor to perform different functions, among which fibroblasts are the most abundant. The dynamics of the mutual relationship change as the sides undertake an epic battle for control of the other. In the process, the cancer "wounds" the microenvironment through a variety of mechanisms and attracts distant mesenchymal stem cells to change their function from one attempting to suppress the cancer, to one that supports its growth, survival, and metastasis. Analogous reciprocal interactions occur as well between disseminated cancer cells and the metastatic microenvironment, where the microenvironment attempts to eliminate cancer cells or suppress their proliferation. However, the altered microenvironmental cells acquire novel characteristics that support malignant progression. Investigations have attempted to use these traits as targets of novel therapeutic approaches.
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Affiliation(s)
- Robert Wieder
- Rutgers New Jersey Medical School and the Cancer Institute of New Jersey, Newark, NJ 07103, USA
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Pinkhasov I, Kabakov L, Nemcovsky CE, Weinreb M, Schlesinger P, Bender O, Gal M, Bar DZ, Weinberg E. Single-cell transcriptomic analysis of oral masticatory and lining mucosa-derived mesenchymal stromal cells. J Clin Periodontol 2023; 50:807-818. [PMID: 36864739 DOI: 10.1111/jcpe.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/25/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
AIM To reveal the heterogeneity of ex vivo-cultured human mesenchymal stromal cells derived from either masticatory or lining oral mucosa. MATERIALS AND METHODS Cells were retrieved from the lamina propria of the hard palate and alveolar mucosa of three individuals. The analysis of transcriptomic-level differences was accomplished using single-cell RNA sequencing. RESULTS Cluster analysis clearly distinguished between cells from the masticatory and lining oral mucosa, and revealed 11 distinct cell sub-populations, annotated as fibroblasts, smooth muscle cells or mesenchymal stem cells. Interestingly, cells presenting a mesenchymal stem cell-like gene expression pattern were predominantly found in masticatory mucosa. Although cells of masticatory mucosa origin were highly enriched for biological processes associated with wound healing, those from the lining oral mucosa were highly enriched for biological processes associated with the regulation of epithelial cells. CONCLUSIONS Our previous work had shown that cells from the lining and masticatory oral mucosae are phenotypically heterogeneous. Here, we extend these findings to show that these changes are not the result of differences in averages but rather represent two distinct cell populations, with mesenchymal stem cells more common in masticatory mucosa. These features may contribute to specific physiological functions and have relevance for potential therapeutic interventions.
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Affiliation(s)
- Ilan Pinkhasov
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liron Kabakov
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carlos E Nemcovsky
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miron Weinreb
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Schlesinger
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Bender
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maayan Gal
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Z Bar
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Evgeny Weinberg
- Department of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Döding A, Hüfner M, Nachtsheim F, Iffarth V, Bölter A, Bastian A, Symmank J, Andreas N, Schädel P, Thürmer M, Becker K, Wolf M, Jacobs C, Kamradt T, Koeberle A, Werz O, Sigusch B, Schulze-Späte U. Mediterranean diet component oleic acid increases protective lipid mediators and improves trabecular bone in a Porphyromonas gingivalis inoculation model. J Clin Periodontol 2023; 50:380-395. [PMID: 36384158 DOI: 10.1111/jcpe.13751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
AIM Therapeutic modulation of bacterial-induced inflammatory host response is being investigated in gingival inflammation and periodontal disease pathology. Therefore, dietary intake of the monounsaturated fatty acid (FA) oleic acid (OA (C18:1)), which is the main component of Mediterranean-style diets, and saturated FA palmitic acid (PA (C16:0)), which is a component of Western-style diets, was investigated for their modifying potential in an oral inoculation model of Porphyromonas gingivalis. MATERIALS AND METHODS Normal-weight C57BL/6-mice received OA- or PA-enriched diets (PA-ED, OA-ED, PA/OA-ED) or normal standard diet for 16 weeks and were inoculated with P. gingivalis/placebo (n = 12/group). Gingival inflammation, alveolar bone structure, circulating lipid mediators, and in vitro cellular response were determined. RESULTS FA treatment of P. gingivalis-lipopolysaccharide-incubated gingival fibroblasts (GFbs) modified inflammatory activation, which only PA exacerbated with concomitant TNF-α stimulation. Mice exhibited no signs of acute inflammation in gingiva or serum and no inoculation- or nutrition-associated changes of the crestal alveolar bone. However, following P. gingivalis inoculation, OA-ED improved oral trabecular bone micro-architecture and enhanced circulating pro-resolving mediators resolvin D4 (RvD4) and 4-hydroxydocosahexaenoic acid (4-HDHA), whereas PA-ED did not. In vitro experiments demonstrated significantly improved differentiation in RvD4- and 4-HDHA-treated primary osteoblast cultures and reduced the expression of osteoclastogenic factors in GF. Further, P. gingivalis infection of OA-ED animals led to a serum composition that suppressed osteoclastic differentiation in vitro. CONCLUSIONS Our results underline the preventive impact of Mediterranean-style OA-EDs by indicating their pro-resolving nature beyond anti-inflammatory properties.
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Affiliation(s)
- Annika Döding
- Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Jena, Germany
| | - Mira Hüfner
- Department of Orthodontics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Franziska Nachtsheim
- Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Jena, Germany
| | - Viktoria Iffarth
- Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Jena, Germany
| | - Anna Bölter
- Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Jena, Germany
| | - Asisa Bastian
- Department of Orthodontics, University Hospital RWTH Aachen, Aachen, Germany
| | - Judit Symmank
- Department of Orthodontics, University Hospital Jena, Jena, Germany
| | | | - Patrick Schädel
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany
| | - Maria Thürmer
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany
| | - Kathrin Becker
- Department of Orthodontics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Wolf
- Department of Orthodontics, University Hospital RWTH Aachen, Aachen, Germany
| | - Collin Jacobs
- Department of Orthodontics, University Hospital Jena, Jena, Germany
| | | | - Andreas Koeberle
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany.,Michael Popp Institute and Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, Innsbruck, Austria
| | - Oliver Werz
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany
| | - Bernd Sigusch
- Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Jena, Germany
| | - Ulrike Schulze-Späte
- Section of Geriodontics, Department of Conservative Dentistry and Periodontology, Center of Dental Medicine, University Hospital Jena, Jena, Germany
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Ultrastructural Characterization of Human Gingival Fibroblasts in 3D Culture. Cells 2022; 11:cells11223647. [PMID: 36429075 PMCID: PMC9688082 DOI: 10.3390/cells11223647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Cell spheroids are applied in various fields of research, such as the fabrication of three-dimensional artificial tissues in vitro, disease modeling, stem cell research, regenerative therapy, and biotechnology. A preclinical 3D culture model of primary human gingival fibroblasts free of external factors and/or chemical inducers is presented herein. The ultrastructure of the spheroids was characterized to establish a cellular model for the study of periodontal tissue regeneration. The liquid overlay technique was used with agarose to generate spheroids. Fibroblasts in 2D culture and cell spheroids were characterized by immunofluorescence, and cell spheroids were characterized by optical and scanning electron microscopy, energy-dispersive X-ray spectroscopy, backscattered electrons, and Fourier transform infrared spectroscopy. Ostegenic related genes were analyzed by RT-qPCR. Gingival fibroblasts formed spheroids spontaneously and showed amorphous calcium phosphate nanoparticle deposits on their surface. The results suggest that human gingival fibroblasts have an intrinsic potential to generate a mineralized niche in 3D culture.
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Alyami R, Alshehri FA, Al Jasser R, Shaheen S, Mahmood A, Elsafadi MA. Vitamin C stimulates RNA expression of human gingival fibroblasts proliferation and adhesion in cigarette smokers: An in vitro study. Saudi Dent J 2022; 34:298-305. [PMID: 35692237 PMCID: PMC9177866 DOI: 10.1016/j.sdentj.2022.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Smoking and the severity of periodontal disease have long been associated. In Saudi Arabia, tobacco smoking is rising, contributing to the increased demand for products that counter its detrimental effects. The antioxidant properties of vitamin C (vit C) make it a powerful countermeasure to tobacco toxicity. Observation of these effects on human gingival fibroblasts (hGFs) would suggest use of vitamin C in future dental applications. Aim To examine the proliferation, adhesion, and expression of extracellular RNA in human gingival fibroblasts extracted from cigarette smokers when compared to never-smokers, in association with vitamin C. Materials and Methods Human gingival fibroblasts were extracted from Periodontal free sites of healthy adult male participants. Group 1; consisted of Heavy cigarette smokers (n = 1) while group 2 was never-smokers (n = 1). Collected cells were cultured and subcultured in supplemented growth medium. Vitamin C was then induced in the medium at the experimental sixth passage. RNA expression analysis using quantitative reverse transcriptase-polymerase chain reaction was performed to analyze the adhesion, proliferation, and extracellular matrix expression. Results Expression of the adhesion gene (CD44) in the smoker group was significantly downregulated than never-smoker group (p-value = 0.024). After the induction of vitamin C, the smoker samples showed a significant improvement in their gene expression levels. The extracellular genes involved in this study (COL1A1, LAMA3, and TGFB3) were significantly affected by the smoking status. In addition, the proliferation of MK167 and CCNB1 genes in smokers and never-smokers was increased. Conclusion Cigarette smoking affects the overall properties of human gingival fibroblasts’ adhesion, proliferation, and extra-cellular matrix formation. Furthermore, the addition of vitamin C affects these cellular properties in a positive manner.
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Affiliation(s)
- Ruaa Alyami
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
- Corresponding author.
| | - Fahad Ali Alshehri
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Reham Al Jasser
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sameerah Shaheen
- Anatomy Department and Stem Cell Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amer Mahmood
- Anatomy Department and Stem Cell Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mona Ahmed Elsafadi
- Anatomy Department and Stem Cell Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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