The effects of epidermal growth factor, interleukin-1, and phenytoin, alone and in combination, on C19 steroid conversions in fibroblasts

Effects of mechanical stress on human oral mucosa-derived cells

OBJECTIVES

Placement of a denture results in the application of mechanical stress (MS), such as occlusal force, onto the oral mucosa beneath the denture. To better understand the molecular mechanism underlying MS-induced inflammation in the oral mucosa, we examined the impact of MS on human oral epithelial cells (HO-1-N-1) and human fibroblasts (HGFs) in this study.

MATERIALS AND METHODS

MS was applied on HO-1-N-1 and HGFs using a hydrostatic pressure apparatus. The expression and production of inflammatory cytokines and growth factors were examined by real-time RT-PCR and ELISA. MS-induced intracellular signal transduction via MAP kinase (MAPK) was also examined.

RESULTS

1 MPa MS resulted in a significant increase in inflammatory cytokines, and 3 MPa MS resulted in a significant increase in FGF-2. MS also increased p-38 phosphorylation and the addition of a p-38 inhibitor significantly suppressed the production of inflammatory cytokines.

DISCUSSION

Our study suggested that MS applied through a denture increases the production of inflammatory cytokines from oral mucosal epithelial cells and fibroblasts via the p38 MAPK cascade. These responses to MS likely lead to inflammation of the mucosal tissue beneath dentures. On other hand, up-regulation of growth factors is likely a manifestation of the biological defense mechanism against excessive MS.

Diphenylhydantoin promotes proliferation in the subventricular zone and dentate gyrus

PROBLEM STATEMENT

Diphenylhydantoin (phenytoin) is an antiepileptic drug that generates hyperplasia in some tissue by stimulating Epidermal Growth Factor (EGFR) and Platelet-Derived Growth Factor beta (PDGFR-β) receptors and by increasing serum levels of basic fibroblast growth factor (bFGF, FGF2 or FGF-β). Neural stem cells in the adult brain have been isolated from three regions: the Subventricular Zone (SVZ) lining the lateral wall of the lateral ventricles, the Subgranular Zone (SGZ) in the dentate gyrus at the hippocampus and the Subgranular Zone (SZC) lining between the hippocampus and the corpus callosum. Neural stem cells actively respond to bFGF, PDGFR-β or EGF by increasing their proliferation, survival and differentiation. The aim of this study was to evaluate the effect of phenytoin on proliferation and apoptosis in the three neurogenic niches in the adult brain.

APPROACH

We orally administrated phenytoin with an oropharyngeal cannula for 30 days: 0 mg kg^-1 (controls), 1, 5, 10, 50 and 100 mg kg^-1. To label proliferative cells, three injections of 100 mg kg^-1 of BrdU was administrated every 12 h. Immunohistochemistry against BrdU or Caspase-3 active were performed to determine the number of proliferative or apoptotic cells.

RESULTS

Our results showed that phenytoin induces proliferation in the SVZ and the SGZ in a dose-dependent manner. No statistically significant effects on cell proliferation in the SCZ neither in the apoptosis rate at the SVZ, SGZ and SCZ were found.

CONCLUSION

These data indicate that phenytoin promotes a dose-dependent proliferation in the SVZ and SGZ of the adult brain. The clinical relevance of these findings remain to be elucidated.

Flutamide inhibits nifedipine- and interleukin-1 beta-induced collagen overproduction in gingival fibroblasts

BACKGROUND AND OBJECTIVE

To understand the role of the androgen receptor in gingival overgrowth, the effects of flutamide on interleukin-1 beta- and nifedipine-induced gene expression of connective tissue growth factor (CTGF/CCN2) and collagen production in gingival fibroblasts were examined.

MATERIAL AND METHODS

Gingival fibroblasts from healthy subjects and patients with dihydropyridine-induced gingival overgrowth (DIGO) were used. Confluent cells were treated with nifedipine, interleukin-1 beta or both. The mRNA expression was examined using real-time polymerase chain reaction, and the concentration of total soluble collagen in conditioned media was analysed by Sircol Collagen Assay. In addition, the protein expressions of androgen receptor, CTGF/CCN2 and type I collagen in gingival tissue were determined by western blot.

RESULTS

Interleukin-1 beta was more potent than nifedipine in stimulating CTGF/CCN2 and procollagen alpha1(I) mRNA expression, and there was an additive effect of the two drugs. Healthy cells exhibited an equal or stronger response of procollagen alpha1(I) than those with DIGO, but DIGO cells displayed a stronger response in the secretion of soluble collagen in the same conditions. Flutamide, an androgen receptor antagonist, inhibited stimulation by nifedipine or interleukin-1 beta. Additionally, the protein expressions of androgen receptor and type I collagen were higher in DIGO gingival tissue than those in healthy gingival tissue.

CONCLUSION

The data suggest that both nifedipine and interleukin-1 beta play an important role in DIGO via androgen receptor upregulation and that gingival overgrowth is mainly due to collagen accumulation. Flutamide decreases the gene expression and protein production of collagen from dihydropyridine-induced overgrowth cells.

The Effects of Anabolic Androgenic Steroid Abuse on Gingival Tissues

BACKGROUND

Anabolic androgenic steroid (AAS) is the familiar name for synthetic derivatives of the male sex hormone, testosterone. A large number of young adults abuse AAS to enhance performance and physical appearance. The aim of this study was to evaluate the effects of AAS abuse on the gingival tissues in a group of bodybuilders and weight lifters.

METHODS

The test group was composed of 24 athletes aged between 17 and 29 years who had been using AAS for >1 year. All subjects were clinically examined for plaque levels (plaque index), gingival inflammation (gingival index), and gingival enlargement. The results were compared to a control group of 20 bodybuilders who had never used AAS drugs and who matched for age, educational level, and oral habits according to the data obtained from the test group.

RESULTS

Although there were no statistical differences between the plaque index (P>0.05) and gingival index (P>0.05) scores of the study group and the control group, the AAS abusers had statistically higher scores of gingival thickness, extent of gingival encroachment, and total gingival enlargement scores (P<0.001 each) compared to non-users.

CONCLUSIONS

The results of this study have revealed that the prolonged use of AAS is closely associated with significant levels of gingival enlargement. Because recreational abuse and abuse in non-competitive sports seem to increase despite legislation, dentists and periodontists should be familiar with the adverse effects of these synthetic derivatives of testosterone on the gingival tissues.

Cyclosporin A specifically affects nuclear PLCbeta1 in immunodepressed heart transplant patients with gingival overgrowth

One of the most commonly observed adverse effects of cyclosporin A (CsA) is the development of gingival overgrowth (GO). Fibroblasts are involved in GO, but the question why only a percentage of patients undergoing CsA treatment shows this side-effect remains unanswered. In a previous study, CsA has been demonstrated to induce over-expression of phospholipase C (PLC) beta(1) in fibroblasts of patients with clinical GO, in cells from both enlarged and clinically healthy gingival sites. In this work, we assessed the expression of PLCbeta isoforms to investigate whether the exaggerated fibroblast response to CsA related to increased PLCbeta(1) expression could also be detected in CsA-treated patients without clinical signs of GO. Our results support the hypothesis of a multi-factorial origin of gingival overgrowth, including specific changes within the gingival tissues orchestrating fibroblastic hyper-responsiveness as a consequence of a long-term in vivo exposure to cyclosporin A.

Androgen metabolic response to indomethacin and the alkaline phosphatase inhibitor levamisole in fibroblasts

OBJECTIVES

The aim of this investigation is to study the effects of indomethacin (I) and the alkaline phosphatase (ALP) inhibitor levamisole (L) on androgen 5alpha-reductase expression in gingival and periosteal fibroblasts, in the context of repair in the periodontium. Chronically inflamed human gingival fibroblasts (HGF) were used to demonstrate the comparative effects of L on HGF and human oral periosteal fibroblasts (HPF).

MATERIAL AND METHODS

Monolayer cultures of six cell lines of HPF of the fifth to ninth passage were incubated in duplicate with 14C-testosterone/14C-4-androstenedione as substrates in Eagle's MEM; I was added at concentrations of 1 and 3 microg/ml in the presence or absence of the established inhibitory concentration of 30 microg/ml L and incubated for 24 h. The medium was solvent extracted for radioactive metabolites, separated by thin layer chromatography and quantified.

RESULTS

L caused 50% inhibition of 5alpha-reductase and 17beta-hydroxysteroid dehydrogenase activity in HGF. In HPF, 5alpha-reductase expression was enhanced by I with both substrates, by 65-76% (n = 6; p<0.01), inhibited by 30-50% (n = 6; p<0.01) with L and restored to control values in combination.

CONCLUSION

Yields of androgen metabolites may be linked to ALP activity, with implications on healing, during adjunctive treatment of inflammatory periodontal disease with I.

Phenytoin-mediated androgen metabolism in gingival fibroblasts. Effects of the antiandrogen finasteride and the alkaline phosphatase inhibitor levamisole

OBJECTIVES

This investigation attempts to identify the role of the alkaline phosphatase inhibitor levamisole (L) and the antiandrogen finasteride (F) on 5alpha-reductase activity in gingival fibroblasts, to elucidate mechanisms for phenytoin-induced gingival overgrowth.

MATERIAL AND METHODS

Human gingival fibroblasts were incubated with Eagle's MEM and 14C-testosterone/14C-4-androstenedione as substrates; effective concentrations of phenytoin (Ph), levamisole (L) and finasteride (F), alone and in combinations of (Ph + F) (Ph + L) were added to the incubate. After 24 h, the medium was analysed for steroid metabolites and quantified using a radioisotope scanner.

RESULTS

The metabolites isolated were 5alpha-dihydrotestosterone (DHT), 4-androstenedione (4-A) or testosterone (T) from each substrate. With 14C-T as substrate, Ph stimulated DHT synthesis by 1.7-fold, while F and L inhibited this activity by 1.8-fold and 34%, respectively (n = 6; P < 0.001). The combination of Ph + F reduced yields by 2.7-fold compared with Ph alone and Ph + L reduced DHT synthesis by 2.4-fold compared with Ph alone (n = 6; P < 0.001). When 14C-4-androstenedione was used as substrate, similar trends were identified.

CONCLUSION

These results suggest that the alkaline phosphatase inhibitor levamisole and the 5alpha-reductase inhibitor finasteride can substantially decrease the yields of DHT in fibroblasts, stimulated by phenytoin. This could be a potential target for reducing the gingival overgrowth caused by phenytoin.

Immunohistochemical analysis of epidermal growth factor receptor in cyclosporin A-induced gingival overgrowth

Cyclosporin A (CsA)induced gingival overgrowth represents a tissue of fibrosis and epidermal growth factor (EGF) has been shown to induce extracellular matrix synthesis by fibroblasts. The purpose of this study was to evaluate the expression of EGF-receptor (EGF-r) in frozen sections of CsA-induced overgrown gingival tissue using immunohistochemical and semiquantitative techniques. Gingival biopsies were obtained from 12 renal transplant patients receiving CsA as well as 9 systemically and periodontally healthy individuals. Immunohistochemical staining procedures were carried out in frozen sections of gingival tissue and the expression of EGF-r was compared between the two study groups. The expression of EGF-r was more pronounced in the oral gingival epithelium of CsA-induced overgrown gingiva as compared to those of the clinically healthy gingival specimens. The reactivity in the inflammatory infiltrate and connective tissue cells of both of the study groups was similar. In conclusion, the results of the present study may suggest that CsA affects EGF-r metabolism in gingival keratinocytes resulting in an increased number of cell surface receptors, which may eventually play a role in the pathogenesis of gingival tissue alterations.

The effects of human mast-cell products and of phenytoin on androgen 5alpha-reductase expression in human gingival fibroblasts

The aim was to elucidate mechanisms for phenytoin-induced gingival overgrowth, using effects of type 1 human mast cell (HMC-1) supernatant and histamine on the expression of 5alpha-reductase in human gingival fibroblasts (HGF), and the effects of phenytoin on this activity. Duplicate incubations of HGF in Eagle's minimum essential medium (MEM) were performed with [14C] testosterone and serial concentrations of mast-cell histamine (1-100 microgram/ml)/HMC-1 culture supernatant at serial dilutions of 1-100 microl/ml for 24 h. Other experiments employed optimal concentrations of HMC-1 supernatant (10 microl/ml) or histamine (8 microgram/ml) and phenytoin (1 and 5 microgram/ml), alone and in combination, using two androgen substrates, [14C] testosterone and [14C] 4-androstenedione. At the end of a 24-h incubation the medium was solvent-extracted for steroid metabolites, analysed and quantified in a radioisotope scanner. HMC-1, histamine (n=3) and phenytoin (n=6) significantly increased the synthesis of dihydrotestosterone and 4-androstenedione by up to 80% (P<0.01); the combination of HMC-1 and phenytoin caused two-fold increases (n=6; P<0.01). The incubations with histamine alone and in combination with phenytoin showed significant stimulation of dihydroxytestosterone and the diols alone and in combination, which was less pronounced in combination. This investigation demonstrates significant stimulation of 5alpha-reductase activity in human gingival fibroblasts by mast-cell supernatant and a specific product histamine, alone and in combination with phenytoin. Androgen 5alpha-reductase-mediated anabolic actions in connective tissue are well documented. The findings suggest a novel hypothesis that mast-cell mediated androgen action in the gingiva in response to phenytoin could contribute to gingival overgrowth.

Cyclosporin A upregulates phospholipase C beta1 in fibroblasts from gingival overgrowth

BACKGROUND

In an attempt to evaluate the influence of cyclosporin A (CsA) on fibroblast metabolism, the phospholipase C beta1, (PLC beta1) nuclear expression was evaluated in fibroblasts from heart transplantation patients treated with CsA who exhibited gingival overgrowth (GO) and from controls.

METHODS

PLC beta1 was assessed by immunoblotting and immunocytochemistry means.

RESULTS

Findings did not show any difference in terms of PLC beta1 expression between the 2 groups when fibroblasts were incubated in media without CsA, while the addition of CsA highly stimulated the fibroblasts from CsA-treated patients compared to controls. The abnormal fibroblastic response in CsA-treated patients was detected both in cells from enlarged gingival sites and in cells from clinically healthy gingival sites.

CONCLUSIONS

These results do not explain whether the exaggerated reactivity to in vitro CsA is the consequence of a genetically transmitted susceptibility to CsA that identifies those subjects at risk for developing GO, or whether it is a secondary effect of the long-term in vivo exposure to CsA. However, the present data underline the lack of any close relationship between enhanced fibroblast activity and clinical signs of GO and support the hypothesis that some other factors, together with CsA, are involved in the pathogenesis of CsA-induced GO.

The effect of minocycline on the metabolism of androgens by human oral periosteal fibroblasts and its inhibition by finasteride

The antimicrobial minocycline has matrix-stimulatory effects on connective tissue and bone. The aim here was to study the effect of minocycline on 5alpha reduction of androgen substrates to 5alpha-dihydrotestosterone (DHT) in periosteal fibroblasts and the influence of the antiandrogen finasteride on this conversion. Confluent cultures of periosteal fibroblasts established from oral periosteum isolated from the bone surface were incubated in duplicate in multiwell dishes with two androgen substrates, [(14)C]-testosterone/[(14)C]-4-androstenedione, in the presence or absence of serial concentrations of minocycline or the antiandrogen finasteride or the two in combination for 24 h. The metabolites formed were solvent-extracted with ethyl acetate, separated by thin-layer chromatography and quantified using a radioisotope scanner. Both androgen substrates were metabolized to DHT and 4-androstenedione or testosterone. Minocycline stimulated the synthesis of DHT from these substrates by 75-83% at 20-30 microg/ml (n=4; p<0.01). Finasteride inhibited the 5alpha-reductase activity of these substrates by 3-5-fold at 1 microg/ml and 40-80% at 0.01 and 0.1 microg/ml (n=4; p<0.01), with little change in 17beta-hydroxysteroid dehydrogenase activity. Minocycline and finasteride in combination showed an intermediate response with one substrate. As finasteride inhibits the type 2, 5alpha-reductase isoenzyme associated with anabolic functions, these findings demonstrate target-tissue androgen metabolic activity in periosteal fibroblasts at baseline and in response to minocycline. This has implications for the reparatory potential of the diseased periodontium during adjunctive treatment with minocycline.

A clinical review of drug-induced gingival overgrowths

There is an increasing number of medications associated with gingival overgrowth. These medications are used to treat a number of common conditions in the Australian population and as such dentists can expect to manage a number of patients with medication-related gingival overgrowth. This review highlights the clinical features and management of the common overgrowths associated with anticonvulsants, immunosuppressants and the calcium channel blockers.

The uptake of two androgen substrates by cultured human gingival fibroblasts in response to minocycline and metabolic studies using a cell-free system

The uptake of two androgen substrates by cultured fibroblasts and the anabolic response of homogenates of cultured gingival fibroblasts to minocycline were investigated. Monolayer cultures of confluent fibroblasts were incubated with [14C]testosterone/[14C]4-androstenedione for timed intervals in the presence or absence of optimal concentrations of minocycline. The intracellular uptake of androgens was quantified by radio-isotope counts on cell digests. Confluent gingival fibroblasts were homogenized by snap freezing/rapid thawing and duplicate incubations were made in phosphate-buffered saline (pH 6.5) with radiolabelled androgens, in the presence or absence of minocycline, for 24 h. At the end of the incubation period the buffer was extracted for radioactive metabolites, analysed and quantified with a radio-isotope scanner. There were 30% increases in the uptake of androgen substrates in the presence of minocycline (n=3; p < 0.01; one-way ANOVA). With the metabolic studies there were 2-3-fold increases in the formation of dihydrotestosterone from [14C]testosterone and [14C]4-androstenedione, respectively (n=4; p < 0.001; one-way ANOVA), and 4-fold/2-fold increases in the formation of 4-androstenedione/ testosterone from these substrates (n=4; p < 0.001) in response to an optimal concentration of 20 microg/ml of minocycline, compared with control incubations. The presence of minocycline in the incubate significantly increased the activity of the steroid-metabolizing enzymes. This increase might result from increased intracellular availability of steroid substrate and enhanced metabolic activity. Homogenates of cultured gingival fibroblasts are a useful model for studying the anabolic potential of minocycline in gingiva, using C19 steroid substrates.

The effect of PDGF, TGF-beta and IGF in combination on androgen metabolism by fibroblasts

The aim of this investigation is to study growth factor combinations (PDGF/IGF PDGF/TGF-beta and TGF-beta/IGF) on the metabolism of 2 androgen substrates 14C-testosterone/14C-4-androstenedione to the matrix stimulatory androgen 5alpha-dihydrotestosterone (DHT). Human gingival fibroblasts in culture were incubated in Eagle's MEM with the radiolabelled substrates and growth factors for 24 h, when the medium was extracted and analysed for radioactive metabolites. When 14C-testosterone was used as substrate, there was an 80% increase in DHT synthesis over controls with the PDGF/IGF combination (n=7; p<0.01), which was less than the effects of each of the growth factors alone. Similarly, PDGF/TGF-beta resulted in a 2-fold increase in DHT synthesis over controls (n=5; p<0.01) which compared with individual PDGF incubations, and the TGF-beta/IGF combination resulted in a 30% increase in DHT synthesis over controls (n=3; p<0.01); this was less than the 2.8/2.5-fold increases produced individually. Similarly, when 14C-4-androstenedione was used as the substrate, there were 2-fold increases in DHT synthesis in response to combinations of PDGF/IGF and PDGF/TGF-beta (n=5; p<0.01). These results demonstrate feedback inhibition when individually active growth factors function in combination; this may be indicative of mechanisms for physiological homeostasis seen in vivo.

Medication induced gingival overgrowth

A number of idiopathic, pathological and pharmacological reactions may result in an overgrowth of the gingiva. This review concentrates on those overgrowths associated with various pharmacological agents. The pharmaco-kinetics and side effects of each drug associated with gingival overgrowth are discussed along with the clinical and histological features and treatment. By examining the possible pathogeneses for these overgrowths we propose a unifying hypothesis for the causation based around inhibition of apoptosis and decreased collagenase activity modulated by cytoplasmic calcium.