Direct immunofluorescence and immune function in patients with oral lichen planus

Abstract

Background/purpose: Direct immunofluorescence and immune function and patients with oral lichen planusThe etiology of oral lichen planus (OLP) is unknown, our purpose was to evaluate the diagnostic value of direct immunofluorescence (DIF) and to investigate the immune functions in OLP.

Materials and methods: We enrolled 65 patients with suspected lesions of OLP and 47 controls. In all participants, clinical and serologic testing were conducted. The histopathologic and DIF tests were conducted in 65 patients. The severity of OLP was evaluated by reticular/hyperkeratotic, erosive/erythematous, ulcerative (REU) scoring system.

Results: By hematoxylin and eosin (H&E) staining and DIF examination, 71.2% (42/59) were diagnosed as OLP, 28.8% (17/59) were diagnosed as non-OLP. DIF demonstrated 64.3% positive reactivity with 2 distinct distribution patterns and 8 staining patterns. Compared to the controls, serum IgA in OLP was higher (P < 0.01), and serum CD3+ cells, IgM, IgE, C3 and C4 were lower (P < 0.05). Pearson correlation analysis in OLP revealed correlations between REU score and IgM, IgA of DIF (r = 0.54, P = 0.026; and r = 0.56, P = 0.020, respectively), between serum IgG and IgG of DIF (r = 0.51, P = 0.038), between serum CD4+ and the ratio of CD4+/CD8+, IgM in DIF (r = -0.50, P = 0.048; and r = -0.54, P = 0.031, respectively), between serum CD8+ and IgM, IgA in DIF (r = 0.52, P = 0.038; and r = -0.50, P = 0.047, respectively).

Conclusion: A combination of H&E test and DIF is useful for the diagnosis of OLP. Compared to controls, immune changes happen to patients with OLP. There are significant associations between the OLP lesions and general cellular and humoral immune status, localized humoral immune response.

Keywords: Direct immunofluorescence; Histopathologic; Oral lichen planus; REU score; Serologic testing.

Figure 1

Diagnostic algorithm for oral lichen planus and testing process for all the participants. OLP, oral lichen planus; H&E, hematoxylin and eosin staining; DIF; direct immunofluorescence; REU score (REU: reticular/hyperkeratotic, erosive/erythematous, ulcerative); BMZ, basement membrane zone. IgG, Immunoglobulin G; IgA, Immunoglobulin A; IgM, Immunoglobulin M; IgE, Immunoglobulin E; C3, Complement C3; C4, Complement C4.

Figure 2

Clinical presentations, histologic presentations and direct immunofluorescence findings of oral lichen planus. A.D. Clinical presentations of oral lichen planus. A. erosive lesions, case 23; D. reticular lesions, case 34; B.E. Histologic presentations in hematoxylin and eosin staining (original magnification ×500) showed basal cell liquefaction and a band-like dense infiltration of subepithelial lymphocytes. C.F. Direct immunofluorescence findings (original magnification ×200). C. positive complement C3 reactivity with basement membrane zone, case 23; F. positive immunoglobulin M reactivity with lamina propria, case 34.

Figure 3

The correlation analysis between the variables of serological results, DIF results and REU scores. A. correlation coefficients of correlation analysis between these variables. B. p-value of correlation analysis between these variables. DIF; direct immunofluorescence; REU scores (REU: reticular/hyperkeratotic, erosive/erythematous, ulcerative); “Flow_” means the variables of cellular immunity; “Elisa_” means the variables of humoral immunity; “DIF_” means the variables of DIF; correlation analysis method：Pearson correlation.