Sains Malaysiana 42(1)(2013): 65–71

Qualitative and Quantitative Assessment of Immune Cells in Oral Mucosal Lichen Planus (OMLP)

(Penilaian Sel-sel Imun di dalam Mukosa Mulut Lichen Planus (OMLP) Secara Kualitatif dan Kuantitatif)

S. H. Sinon*

Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

A.    M. Rich, N. A. Firth & G. J. Seymour

The Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago

P.O. Box 647, Dunedin, New Zealand

Received: 2 December 2011/Accepted: 18 May 2012

ABSTRACT

Cell mediated immunity is currently thought to be involved in the pathogenesis of oral mucosal lichen planus (OMLP). However, literature reveals there is no large scale data of immunohistochemistry (IHC) study on these immune cell populations. The aim of this study was to assess and compare immune cell surface identification markers CD3, CD4, CD8, CD19 and CD83 between the OMLP (n=40) and non-specific inflammatory lesions (as control group) (n=10) qualitatively and quantitatively. Kruskal-Wallis and Mann Whitney U tests have been used to make comparison between the test and control group, p values of less than 0.05 was considered to be statistically significant. T cell surface markers (CD3+, CD4+ and CD8+), B cells (CD19+) and mature dendritic cells (CD83+) showed intense immunostaining in OMLP tissues with a significantly higher expression of positive cells than in the control group (p<0.05). CD3, CD4 and CD8+ve T cells were the predominant inflammatory cell type in OMLP rather than CD19+ B cells, supporting the role of Th1 cells in the pathogenesis of OMLP. CD83+ mature dendritic cells were present in the least number and were mostly localized to areas where there were aggregates of lymphocyte. There was a positive correlation and direct relationship between T and B lymphocyte subsets whereby as one subset increased, the other follows.

Keywords: Immune cells; immunohistochemistry (IHC); oral mucosal lichen planus (OMLP)

ABSTRAK

Imuniti selular telah diketahui umum terlibat dalam patogenesis lichen planus (OMLP). Walau bagaimanapun, sehingga kini tiada kajian imunohistokimia yang membentangkan pangkalan data secara besar mengenai populasi sel-sel imun di dalam OMLP. Matlamat kajian ini adalah untuk menganalisis dan membandingkan identiti permukaaan sel imun CD3, CD4, CD8, CD19 dan CD83 antara OMLP (n=40) dan kumpulan dengan inflamasi tidak spesifik sebagai kawalan (n=10) secara kuantitatif dan kualitatif. Ujian statistik Kruskal-Wallis dan Mann Whitney U telah digunakan untuk membuat perbandingan antara kumpulan kajian dan kumpulan kawalan, nilai p yang kurang daripada 0.05 dianggap nilai statistik yang signifikan. Kami mendapati sel yang mempunyai identiti permukaan sel T (CD3+, CD4+ dan CD8+), sel B (CD19+) dan sel dendritik yang matang (CD83+) menunjukkan intensiti ‘immunostaining’ yang kuat di dalam tisu OMLP iaitu sel yang menunjukkan ekspresi positif berbanding dengan kumpulan kawalan (p<0.05). Sel T yang positif dengan identiti permukaan CD3, CD4 and CD8 adalah sel inflamasi utama di dalam OMLP berbanding dengan sel B dengan identiti permukaan CD19+ .  Ini menguatkan lagi teori bahawa sel Th1 amat penting dalam patogenesis OMLP. Sel dendritik matang CD83+ hadir dalam jumlah yang kecil dan kebanyakannya tertumpu di kawasan sel limfosit bergumpalan. Terdapat kolerasi positif dan hubungan terus antara subset sel-sel limfosit T dan B, jika satu subset bertambah maka subset yang lain juga turut bertambah.

Kata kunci: Immunohistokimia (IHC); mukosa mulut lichen planus (OMLP); sel imun

REFERENCES

Al-Fouzan, A.S., Habib, M.A., Sallam, T.H., ElSamahy, M.H. & Rostom, A.I. 1996. Detection of T lymphocytes and T lymphocyte subsets in lichen planus: In situ and in peripheral blood. International Journal of Dermatology 35(6): 426-429.

Axell, T. & Rundquist, L. 1987. Oral lichen-planus - a demographic-study. Community Dentistry and Oral Epidemiology 15(1): 52-56.

Bhan, A.K., Harrist, T.J., Murphy, G.F. & Mihm, M.C. 1981. T-Cell subsets and langerhans cells in lichen planus: In situ characterization using monoclonal antibodies. British Journal of Dermatology 105(6): 617-622.

Boisnic, S., Frances, C., Branchet, M.C., Szpirglas, H. & Lecharpentier, Y. 1990. Immunohistochemical study of oral lesions of lichen-planus - diagnostic and pathophysiologic aspects. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 70(4): 462-465.

Charazinska-Carewicz, K., Ganowicz, E., Krol, M. & Gorska, R. 2008. Assessment of the peripheral immunocompetent cells in patients with reticular and atrophic-erosive lichen planus. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 105(2): 202-205.

Dorrego, M.V., Correnti, M., Delgado, R. & Tapia, F.J. 2002. Oral lichen planus: Immunohistology of mucosal lesions. Journal of Oral Pathology and Medicine 31(7): 410-414.

Eisen, D. 2002. The clinical features, malignant potential and systemic associations of oral lichen planus: A study of 723 patients. Journal of the American Academy of Dermatology 46(2): 207-214.

Gustafson, J., Eklund, C., Wallstrom, M., Zellin, G., Magnusson, B. & Hasseus, B. 2007. Langerin-expressing and CD83-expressing cells in oral lichen planus lesions. Acta Odontologica Scandinavica 65(3): 156-161.

Hirota, J., Osaki, T. & Tatemoto, Y. 1990. Immunohistochemical staining of infiltrates in oral lichen-planus. Pathology Research and Practice 186(5): 625-632.

Jungell, P., Konttinen, Y.T., Nortamo, P. & Malmstrom, M. 1989. Immunoelectron microscopic study of distribution of T-cell subsets in oral lichen planus. European Journal of Oral Sciences 97(4): 361-367.

Khan, A., Farah, C.S., Savage, N.W., Walsh, L.J., Harbrow, D.J. & Sugerman, P.B. 2003. Th1 cytokines in oral lichen planus. Journal of Oral Pathology and Medicine 32(2): 77-83.

Lodi, G., Scully, C., Carrozzo, M., Griffiths, M., Sugerman, P.B. & Thongprasom, K. 2005. Current controversies in oral lichen planus: Report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 100(1): 40-51.

Mahood, J.M. 1981. Serum immunoglobulins in lichen planus. British Journal of Dermatology 104(2): 207-208.

Pindborg, J.J., Reichart, P., Smith, C.J. & van der Waal, I. 1997. WHO International Histological Classification of Tumors: Histological Typing of Cancer and Precancer of the Oral Mucosa 2nd ed. Springer-Verlag.

Porter, S.R., Kirby, A., Olsen, I. & Barrett, W. 1997. Immunologic aspects of dermal and oral lichen planus: A review. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 83(3): 358-366.

Rodriguez-Nunez, I., Blanco-Carrion, A., Garcia, A.B. & Rey, J.G. 2001. Peripheral T-cell subsets in patients with reticular and atrophic-erosive oral lichen planus. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 91(2): 180-188.

Scully, C., Beyli, M., Ferreiro, M.C., Ficarra, G., Gill, Y., Griffiths, M., Holmstrup, P., Mutlu, S., Porter, S. & Wray, D. 1998. Update on oral lichen planus: Etiopathogenesis and management. Critical Reviews in Oral Biology and Medicine 9(1): 86-122.

Sugerman, P.B., Satterwhite, K. & Bigby, M. 2000. Autocytotoxic T-cell clones in lichen planus. British Journal of Dermatology 142(3): 449-456.

Sugerman, P.B. & Savage, N.W. 2002. Oral lichen planus: Causes, diagnosis and management. Australian Dental Journal 47(4): 290-297.

Sugerman, P.B., Savage, N.W., Walsh, L.J., Zhao, Z.Z., Zhou, X.J., Khan, A., Seymour, G.J. & Bigby, M. 2002. The pathogenesis of oral lichen planus. Critical Reviews in Oral Biology and Medicine 13(4): 350-365.

Thornhill, M.H. 2001. Immune mechanisms in oral lichen planus. Acta Odontologica Scandinavica 59(3): 174-177.

Walsh, L.J., Ishii, T., Savage, N.W., Gemmell, E. & Seymour, G.J. 1990. Immunohistologic analysis of epithelial cell populations in oral lichen planus. Journal of Oral Pathology and Medicine 19(4): 177-181.

Walsh, L.J., Savage, N.W., Ishii, T. & Seymour, G.J. 1990. Immunopathogenesis of oral lichen planus. Journal of Oral Pathology and Medicine 19(9): 389-396.

Walton, L.J., Macey, M.G., Thornhill, M.H. & Farthing, P.M. 1998. Intra-epithelial subpopulations of T lymphocytes and Langerhans cells in oral lichen planus. Journal of Oral Pathology and Medicine 27(3): 116-123.

Zhou, X.J., Sugerman, P.B., Savage, N.W., Walsh, L.J. & Seymour, G.J. 2002. Intra-epithelial CD8(+) T cells and basement membrane disruption in oral lichen planus. Journal of Oral Pathology and Medicine 31(1): 23-27.

*Corresponding author; email: suraya6179@yahoo.com