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CONNECTIVE TISSUE METABOLISM AND GINGIVAL OVERGROWTH

Boston University Goldman School of Dental Medicine, Department of Periodontology and Oral Biology, Division of Oral Biology, 700 Albany Street, W-210, Boston, MA 02118;

View larger version (19K): [in this window] [in a new window]   Figure 1. Elements of tyrosine kinase receptor signal transduction pathways showing the role of Sos1. Ligand (L) binds to tyrosine kinase receptor (R), leading to phosphorylations in the cytoplasmic domain of the receptor (p). This recruits adapter proteins (Grb2 and Shc) and Sos1. Bound Sos1 then catalyzes the substitution of GTP for GDP on plasma-membrane-bound Ras proteins. Active GTP/Ras then activates protein kinases, ultimately resulting in activation and translocation of transcription factors to the nucleus, and regulation of transcription of specific target genes.

View larger version (32K): [in this window] [in a new window]   Figure 2. Summary of functional interactions in drug-induced gingival overgrowth. Fibrogenic drugs (phenytoin, nifedipine, cyclosporin A) are envisioned to alter the phenotypes of inflammatory cells (principally lymphocytes and macrophages), resulting in the observed abnormal balances of cytokines and inflammatory mediators. This would result in distortion of normal responses to bacterial insults and injury, as follows: A subset of cytokines would influence gingival fibroblast extracellular matrix metabolism and proliferation. For example, in the case of TGF-β1 overexpression in phenytoin-induced gingival overgrowth, fibroblasts produce and accumulate CTGF that has direct and indirect effects on extracellular matrix production, cell/extracellular matrix (ECM) interactions, and activity of other growth factors and cytokines, and gingival fibroblast extracellular matrix production (block arrows). By contrast, increased FGF-2 is seen as principally a mitogenic factor that stimulates gingival fibroblast proliferation. In addition, unique aspects of gingival fibroblast metabolism are believed to confer tissue-specific features of extracellular matrix metabolism in gingiva.

Critical Reviews in Oral Biology & Medicine, Vol. 15, No. 3, 165-175 (2004)
DOI: 10.1177/154411130401500305


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