Rajesh E, Kurupaa R. J, Kasthuri M, Balachander N. Role of Mast Cell in Oral Pathology. Biomed Pharmacol J 2016;9(2).
Manuscript received on :June 12, 2016
Manuscript accepted on :August 17, 2016
Published online on: 27-08-2016
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E. Rajesh, R. Jayasri Kurupaa, M. Kasthuriand  N. Balachander

Department of Oral Pathology, Sree Balaji Dental College and Hospital, Bharath University, Pallikaranai, Chennai-600100.

DOI : https://dx.doi.org/10.13005/bpj/1027

Abstract

In oral tissues,the mast cell releases various pro-inflammatory cytokine tumor necrosis factor alpha (TNF-Ü) which stimulate leukocyte infiltration in various inflammatory condition of oral cavity such as oral lichen planus (OLP), periapical lesions, gingivitis & periodontitis. Mast cells are the local residents of the connective tissue and plays an important role in immunopathology and producing mitogenic cytokines.These cells plays a role in pathogenesis of oral diseases.

Keywords

tissues; releases; various

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Introduction

Mast cells are granulated cells and appears as a large spherical cells which is present in all of the connective tissue elements including skin, submucosa or connective tissue of various organs and mucosal epithelial tissues & also in dental pulp1,2. Life span of weeks to months.It is derived from bonemarrow and it contains granules granules are rich in heparin, chondroitin sulphate, proteoglycan and numerous enzymes including collagenase.These granules are metachromatic in nature and it is confirmed with staining such as Toludine blue.

Ultrastructure of Mast Cell :

Three types of mast cell :In deeper connective tissue,the cells (except that in close vicinity to blood vessels) appears as round /oval in shape & dark purple in colour. The borders of cell are well defined & nucleus is not visible due to granules called as intact cells3

In the superficial connective tissue, the mast cells appear flattened / irregular and the cytoplasm appears granular immediately below the infiltrate area and near the blood vessels . The cell borders are not defined and the nucleus is only partially appreciable; these are called spreading cells4.

The third type called degranulated cells found within the infiltrate & appeared paler the staining has reverted from metachromatic violet to light pink, the nucleus blue in color and well defined5

Role of mast cell released cytokines: –

IL-3 – induce basophil recruitment & activation

IL-5-eosinophil recruitment & activation

IL-13 – induction of IgE synthesis

Mast cell bears receptors for IgE and degranulates  this cytophilic antibody is cross-linked by antigen . Mast cell RANTES degranulation can be caused by other factors such as mechanical trauma, complement C5a, eosinophil –derived cationic protein, and bacterial products . In the absence of IgE mediated activation the mast cell can produce inflammation  and its events under many conditions6.

Thus, mast cell release proinflammatory mediators, promotes inflammation and angiogenesis, extracellar  matrix degeneration and tissue remodeling.

Role of MC in Oral Pathologies:

Role of MC in OLP:

Mechanism

RANTES activation

Mast Cells chemotaxis and degranulation

TNF- Ü

Endothelium cell adhesion molecule

expression (Cd62 E, CD54, CD106)

Chymase activation

MMP- 9 activation

Disruption of basement membrane

Keratinocyte apoptosis

Intra epithelial CD 8

T-cell migration through BM

Survival of inflammatory cell

Non-specific T-cell recruitment1

Action of mast cell mediators in oral lichen planus leading to the following clinical

and histopathological changes7

Table 1

Mediators Clinical features Histopathologic features
Histamine

. Induces vasopermeability..

. Antigen induced T-cell proliferation Inhibits the neutrophil.

. Induces increased expression of E-selectin, ICAM and ICAM, which

causes leukocytic margination

. Vesicles, bullae and erosive lesions

Chronic persistence of the lesion.

 

Submucosal edema. Traffi cking of T-lymphocytes..

 

TNF-alpha

. Increased production of matrix metalloproteinases like stromyelsin, collagenase.

Destruction of basement membrane

Vesicles, bullae and erosive lesions Necrosis and liquifactive degeneration of basal cell layer.

 

Action of mast cell mediators in oral submucous fi brosis leading to the following

clinical and histological changes7

Table 2

Mediators Clinical features Histopathologic features
Prostaglandins and leukotreines

Increase the mucous gland secretion

Increased venous permeability

 

 

– Excessive salivation. Submucosal edema
Histamine

Causes vasodilatation and vasopermeability.

  Submucosal edema

 

Heparin

. Causes vasoproliferation. –

Petechiae

 

 
Interleukin-5

. Causes growth and differentiation of eosinophils

 

 

Itching sensation

.

In early stages of oral submucous fibrosis consists of Inflammatory infiltrate eosinophils
Eosinophilic chemotactic factor (ECF)

Causing eosinophilic migration

   
Interleukin-1

. Stimulates fibroblastic proliferation.

Decreased mouthopening  Increased collagen fiber bundles.

 

Role of MC in angiogenesis in oral squamous cell carcinoma:

Action of mast cell mediators in oral squamous cell carcinoma leading to the following clinical and histologic

al changes7

Table.3

Mediators Clinical features Histopathologic features
IL-1 AND TNF-alpha

. Causes increased epithelial cell proliferation..

Exophytic growth or a plaque Increased thickness of the epithelium
Heparin

. Causes angiogenesis and type-VIII

Tumour angiogenesis Increased vascularity of the stroma.

 

Role of MC in oral leukoplakia:

Action mast cell mediators in oral leukoplakia leading to the following clinical and histological changes7

Table.4

Mediators Clinical features Histopathologic features
Histamine

. Enhances permeability across the epithelial surface. Antigen induced T-cell proliferation.

Chronicity of the lesion Increased mucosal permeability despite hyperkeratosis

 

Heparin

. Causes endothelial cell proliferation and migration

Erosive leukoplakia. Increased vascularity of the stroma

and ulceration.

Interleukin-1 and TNF

. Increased epithelial cell proliferation.

White patch or a plaque Increased thickness of the epithelium.

 

Role of MC in Periapical lesions

Mechanism

Role of MC in Pyogenic Granuloma

MC + neuropeptides

neural immune network with LC  in mucosal tissue

Degranulation of MC

Cytokine, vasoactive amine and enzyme

Inflammatory and vascular changes

Pyogenic granuloma

Role of MC in wound healing

Wound healing is a dynamic process consisting of four phases:

  1. Homeostasis
  2. Inflammation
  3. Proliferation

d. Tissue remodeling and resolution

MC  activate  fibroblast

enzyme

tryptase

synthesis collagen + hyaluronic acid

fibrous tissue formation

MC + fibroblast13

fibronectin integrin

receptor

Wound healing

Wound healing involves degradation, cell migration, synthesis of  fibronectin, fibrin and high amount of collagen type II and matrix remodeling to return the tissue to normality

 

III.  MMP – 9 from mast cell →

Wound healing1

Role of mast cell in peripheral ossifying fibroma9:

 

Figure 1 Figure 1

 

Click here to view figure

 

Conclusion

This article mainly focus that all oral reactive lesions have MCs , thus having a possible role in pathogenesis of these lesions.In recent years. Mast cells have gained a lot of importance owing to the vast number of chemical mediators  released by them with wide range of actions in various disease processes. Once confirmed, it makes easier for us to target the therapeutic modalities against mast cells and the granules it contains to alter the course of disease/lesion.

Reference

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