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Lichen planus (LP) is a common chronic inflammatory condition that can affect skin and mucous membranes, including the oral mucosa. Because of the anatomic, physiologic and functional peculiarities of the oral cavity, the oral variant of LP (OLP) requires specific evaluations in terms of diagnosis and management. In this comprehensive review, we discuss the current developments in the understanding of the etiopathogenesis, clinical-pathologic presentation, and treatment of OLP, and provide follow-up recommendations informed by recent data on the malignant potential of the disease as well as health economics evaluations.

To investigate the association between Epstein Barr virus (EBV) and Oral Lichen Planus (OLP) in both of its clinical phenotypes (erosive and non-erosive), 33 OLP cases divided into erosive and non-erosive phenotypes, and 26 non-OLP cases were evaluated for the presence of EBV using In Situ Hybridization. Immunohistochemistry was used to assess expressions of CD3, CD20, CD138 and p53 in both OLP clinical phenotypes. EBV was detected in 11 (33%) of the OLP cases and none of the non-OLP cases ( p  = 0.002). CD3 and CD20 were both over-expressed in all OLP cases, however CD138 was significantly over-expressed in the erosive OLP phenotype by comparison to the non-erosive one ( p  = 0.003), suggesting a possible role of plasma cell in erosive OLP. There was no association between EBV and CD-138, nor with erosive OLP. Interestingly however, EBV had an association with p53 expression among OLP cases ( p  = 0.038), inferring a role of EBV in possible neoplastic changes in OLP. There appears to be a potential role of EBV in causing at least some OLP cases, regardless of whether OLP is erosive or not. EBV might have an etiological role in causing some OLP cases. This could explain why some OLP cases are recalcitrant to corticosteroids treatment. Clinical trials are needed to establish whether EBV-infected OLP cases respond to antiviral therapy.

Saliva is a highly versatile biological fluid that is easy to gather in a non-invasive manner—and the results of its analysis complement clinical and histopathological findings in the diagnosis of multiple diseases. The objective of this review was to offer an update on the contribution of salivary biomarkers to the diagnosis and prognosis of diseases of the oral cavity, including oral lichen planus, periodontitis, Sjögren’s syndrome, oral leukoplakia, peri-implantitis, and medication-related osteonecrosis of the jaw. Salivary biomarkers such as interleukins, growth factors, enzymes, and other biomolecules have proven useful in the diagnosis and follow-up of these diseases, facilitating the early evaluation of malignization risk and the monitoring of disease progression and response to treatment. However, further studies are required to identify new biomarkers and verify their reported role in the diagnosis and/or prognosis of oral diseases.

Oral Lichen Planus (OLP) is a chronic inflammatory mucocutaneous disorder of the oral mucosa. Th9 cells secrete IL9, which induces elevated levels of MMP9, exacerbating OLP disease severity. IL9 also increases Th17 levels in OLP lesions. This study aimed to detect IL9 tissue expression in patients with OLP compared to normal controls and to correlate its expression with disease severity and response to intralesional steroid therapy. This study involved 18 patients with OLP and 18 healthy, age- and sex-matched volunteers. The REU scoring system was used to monitor OLP lesions before and after treatment with 20 mg/mL intralesional triamcinolone acetonide every 2 weeks for four sessions. Biopsies for H&E and IL-9 expression were taken from patients and controls, with repeat biopsies after the fourth session for patients. A highly statistically significant increase in IL9 expression was observed in the patient group compared with the control group. A highly statistically significant decrease in both the REU score and post-treatment IL-9 expression was detected in the patient group. We can conclude that IL9 is a tissue marker of OLP activity. Future studies on therapies targeting IL-9 in OLP are needed.

Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa with a recognized risk of malignant transformation. MicroRNAs, particularly miRNA-21 and miRNA-27b, have been implicated in the pathogenesis and progression of various diseases, including OLP. Their altered expression in saliva may provide diagnostic and prognostic insights for this condition. This systematic review examines the expression profiles of miRNA-21 and miRNA-27b in the saliva of OLP patients to assess their potential as biomarkers. The review was conducted in accordance with PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search was conducted in PubMed, Embase, and Scopus using specific keywords. Retrieved titles and abstracts were screened based on predefined eligibility criteria, and relevant studies were analyzed. The initial search identified 71 studies. After screening, 17 abstracts were selected for full-text review. Following evaluation, 11 studies were excluded, resulting in 6 studies being included. Findings indicate a consistent upregulation of miRNA-21 and a downregulation of miRNA-27b in OLP saliva samples. These alterations suggest a potential role in disease pathogenesis and risk assessment. The dysregulation of miRNA-21 and miRNA-27b in OLP underscores their potential as salivary biomarkers for diagnosis and disease monitoring. Moreover, the non-invasive nature of salivary miRNAs offers promising clinical applications, enhancing early detection and personalized management strategies for OLP.

Oral lichen planus (OLP) is a chronic inflammatory mucosal disease with an incompletely understood pathogenesis. This study aimed to investigate the role of disease-specific fibroblasts in OLP. We performed single-cell RNA sequencing on buccal mucosa of 4 OLP patients and one healthy control. Additionally, mRNA expression and immunofluorescence staining were analyzed in primary fibroblasts from 51 OLP patients and 24 healthy individuals. The spatial cellular interactions were assessed using multiplex immunofluorescences in OLP tissues. Using single-cell RNA sequencing, we identified SFRP2+ fibroblasts as the origin of inflammatory fibroblasts in OLP. A subset of SFRP2+ fibroblasts specifically expressed Wnt5a and was implicated in antigen processing and presentation pathway in OLP. Furthermore, SFRP2+Wnt5a+ fibroblasts amplified and maintained the local immune inflammation by interacting with CD8+ T cells and epithelial cells. Compared to the healthy control group, upregulated expressions of pro-inflammatory molecules (CXCL12, CXCL14) and antigen presenting associated molecules (HLA-A, HLA-B, HLA-C and ERAP2) were displayed in OLP group at mRNA level. Colocalization of SFRP2 and Wnt5a was displayed in the primary cultured fibroblasts of OLP . Besides, SFRP2+ Wnt5a+ fibroblasts were located around CD8+ T cells in the superficial layer of the lymphocyte infiltration zone. Our findings reveal the heterogeneity and pathogenic mechanisms of fibroblasts in OLP, providing new insights into the cellular drivers of chronic inflammation in OLP.

Background Oral lichen planus (OLP) is a common chronic inflammatory disease of the oral mucosa with a certain tendency for malignant transformation. The etiology and pathogenesis of OLP remain unclear, and the relationship between psychiatric factors and the development of OLP has attracted much attention in recent years. This study aims to investigate the alterations in oral microbiota and metabolites in OLP patients with psychiatric symptoms, providing a theoretical foundation for understanding the pathogenesis and treatment of OLP. Methods 16S rRNA sequencing was used to evaluate the oral microbial population in a cohort of 105 OLP patients. To further investigate the potential interaction between OLP and psychiatric factors, saliva samples from 64 depressed/anxious OLP patients (D-OLP) and their age-matched healthy controls were selected for 16S rRNA sequencing. The salivary metabolome was also characterized by ultra performance liquid chromatography-mass spectrometry (LC-MS). Results The results of 16S rRNA sequencing showed that significant differences in species classification between OLP patients and healthy controls. The D-OLP group displayed an increased abundance of Pseudomonas as well as dysregulation of associated metabolism activities. Correlation analysis showed that the altered metabolites were involved in the metabolic pathways related to the oral-microbiome-brain axis and affected various physiological processes such as neurotransmitter transmission and oxidative stress, promoting epithelial inflammatory activation and immune responses. These changes ultimately lead to the destruction of the original oral mucosal homeostasis. Conclusions Psychiatric factors may promote mucosal inflammatory responses through dysbiosis of the microbiota. The dysregulated oral microbiome-related metabolites may significantly affect the pathogenesis of the oral-brain axis in OLP patients.This study provides valuable insights into potential future modalities for elucidating the pathogenesis of OLP, offering a foundation for the development of personalized therapeutic strategies.

The IFN-γ-inducible chemokines CXCL9, CXCL10, and CXCL11 play a key role in many inflammatory conditions, particularly those mediated by T cells. Therefore, the production of these chemokines in peripheral tissues could be instrumental in the pathophysiology of tissue-specific immunological diseases such as oral lichen planus (OLP). In the present study, we assessed the production of keratinocyte-derived CXCL9/10/11 under basal and inflammatory conditions and investigated whether these chemokines were involved in the pathogenesis of OLP. We used semi-quantitative PCR, ELISA, chemotaxis assays, and fluorescence-activated cell sorting (FACS) to assess the expression and functional role of CXCL9/10/11 in oral keratinocytes (three strains of normal human oral keratinocytes (NHOK), and the H357 oral cancer cell line) in the presence or absence of IFN-γ. CXCL9/10/11 were also assessed in tissues from normal patients and those with oral lichen planus (OLP). The time course study in oral keratinocytes treated with IFN-γ showed that expression of CXCL9/10/11 chemokines was significantly enhanced by IFN-γ in a time-dependent manner. In particular, CXCL10, a prominent chemokine that was overexpressed by IFN-γ-stimulated NHOK, was able to effectively recruit CD4 lymphocytes, mainly CD4+CD45RA- cells. Significantly higher levels of CXCL9/10/11 were found in tissues from patients with OLP compared to normal oral mucosa. Taken together, the results demonstrate that normal oral keratinocytes produce chemotactic molecules that mediate T cell recruitment. This study furthers understanding of chemokine production in oral keratinocytes and their role in the pathophysiology of oral mucosa, with particular relevance to OLP.

To search for a new classification scheme for oral lichen planus (OLP) and oral lichenoid lesions (OLL) based on innate lymphoid cells (ILCs) and to evaluate the clinical significance of this classification for diagnosis and treatment. This study was based on a clinical cohort and applied flow cytometry to prospectively analyze the ILC subgroups and proportions in OLP and OLL lesions using SPSS software (version 26.0) to attempt cluster analysis to classify diseases at the cellular level based on the phenotype and quantity of ILCs cells, analyze the correlation between the new classification of diseases and clinical risk factors based on the patient's clinical background information and classification results, and evaluate the differences in therapeutic effects among patients in different groups in corresponding clinical cohorts. In the OLP and OLL groups, the ILC compartment consisted mainly of ILC1 (75.02% ± 27.55% and 72.99% ± 25.23%, respectively), ILC2 (1.49% ± 4.12% and 1.72% ± 3.18%, respectively), and ILC3 (16.52% ± 19.47% and 18.77% ± 18.12%, respectively). Using k-means clustering and two-step clustering, patients could be clustered into three groups that did not respond equally to the same treatment. Using k-means clustering, there was a statistically significant difference in REU scores between the ILC1 advantage group and the OLL subgroup before and after treatment ( = 0.02), which was not observed in two-step clustering. This indicates that k-means clustering may have greater value in the clinical application of OLL. In the ILC1 absolute advantage group, using HCQ + TGP for one month could effectively treat the patients regardless of the use of k-means clustering or two-step clustering ( ≤0.001), whereas the other groups did not. This study provides a preliminary OLP and OLL classification method based on ILC subgroups that can guide the cytological classification of diseases to a certain extent. Further clinical application values should be verified in subsequent cohort studies.

Several studies have explored the origin and development mechanism of oral lichen planus (OLP) with limited attention to the role of bacteria in the progression of this common oral disease. Here we utilized MiSeq sequencing of 16S rRNA gene amplicons to identify complex oral microbiota associated with OLP from saliva samples of two subtypes (reticular and erosive) of OLP patients and healthy controls. Our analyses indicated that the overall structure of the salivary microbiome was not significantly affected by disease status. However, we did observe evident variations in abundance for several taxonomic groups in OLP. Porphyromonas and Solobacterium showed significantly higher relative abundances, whereas Haemophilus , Corynebacterium , Cellulosimicrobium and Campylobacter showed lower abundances in OLP patients, as compared with healthy controls. In addition, we explored specific microbial co-occurrence patterns in OLP and revealed significantly fewer linkers of Streptococcus comprising species in erosive OLP. Furthermore, the disease severity and immune dysregulation were also genus-associated, including with Porphyromonas that correlated to disease scores and salivary levels of interleukin (IL)-17 and IL-23. Overall, this study provides a general description of oral microbiome in OLP and it will be useful for further investigation of their potential roles in the initiation and immune modulation of OLP.