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Absence of Langerhans Cells in Oral Hairy Leukoplakia, an AIDS-Associated Lesion

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Absence of Langerhans Cells in Oral Hairy Leukoplakia, an AIDS-Associated Lesion Absence of Langerhans Cells in Oral Hairy Leukoplakia, an AIDS-Associated Lesion Troy E. D aniels, D .D .S., M .S. , Deborah Greenspan, B.D.S. , John S. Greenspan, B. D .S., Ph.D ., Evelyne Lennette, Ph.D., Morten Schi0dt, D.D.S. , D r. Odont. , Vibeke Peters en, B. S., and Yvonne de Souza, M .S. Department of Stomatology, School of Dentistry, University of Ca li fo rnia (TED, DG, JSG , MS, VP, YdeS), Sa n Francisco, California; and Virolab In c. (EL), Berkeley, Cali fo rnia, U .S.A. O ral hairy leuko plakia (HL) is a recently described mani­ tien ts, LC were detected w ith all 3 antibodies in 11/12 festati on o f human immunode fi ciency virus (HlV) infec­ specimens (92%) and were found in approx imately norm al tion in w hich Epstein-Barr virus (EB V) has been sh own numbers w ith at least 1 antibo d y. T here was cl ose corre­ to replicate. T o seek evidence fo r a local defect in mucosal lati on between the absen ce o f LC and positive staining for immunity, w e assessed the presence o f epithelial Lan ger­ E BV, human papillo m a virus antigen s, and candidal h yphae h ans cells (LC ) in these lesions and in autologous no nle­ in the epithelium. W e conclude that LC are absent or greatl y sional mucosa. W e used monoclonal antibodies against HLA­ reduced in the lesions o f HL. Absen ce of n o rmal LC func­ DR, HLA-DQ, and T 6 antigens to identify LC in bio psy ti on m ay be impo rtant in the pathogenesis o f HL and m ay specimens of HL fro m 23 ho m osexual m en. In all lesio n refl ect an event in the pathogenesis o f o ther features of the specimens, LC either were n o t detected or were present acquired immune deficien cy syndro m e. J Invest D el'm ato / only in g reatl y reduced numbers with at least 1 o f the 89:178-182, 1987 antibo dies. In nonlesional o ral mucosa fro m the sam e pa- ral hairy leukoplakia (HL) , a newly described le­ skin-associated lymphoid ti ss ue [5]. They are deri ved from bone sion, is associated with the ultimate development marrow precursors and ca n be recogni zed by electron microscopic of acquired immune deficiency syndrome (AIDS) observa tion ofBirbeck granules and by several antigeni c marke rs, and cl ea rl y contain s Epstein-Barr virus (EBV) and including the histocompatibility antigens HlA-DR and HLA-DQ perhaps other intrae pitheli al viruses [1 ,2]. Foun d and the thymocyte antigen T6 (reviewed in [6]) . Human LC also Opredominal}tl y in immunosuppressed homosexual men and oc­ express the helper-induce r T-Iymphocyte antigen (T 4) , wea kly casionall y in others at risk fo r developing AI DS [3). the lesion in normal skin [71 but strongly in va ri ous inflammatory condi­ appea rs clinica ll y as white, irregul arl y surface d patches on th e tions [8]. lateral margins of the tongue. The lesion is usuall y bil ateral and langerh ans ce ll s are present, alth ough w ith differe nt densities, has a histologic appea rance simil ar to that of the fl at wa rt of skin in essentiall y all areas of normal hu ma n skin and mucosa [9-11]. or the uterine fl at condyloma. The Centers fo r Disease Control In patients with AIDS and opportunisti c in fec tions, the numbers have now pl aced HL in the new classifica ti on of in fec ti ons as­ of LC in cl inica ll y normal skin were reduced more than 60% sociated w ith the human immunodefi ciency virus (HIV) (g roup compared with appropri ate controls [1 2]. We have examined th e lVc- secondary infecti ous diseases) [4] . numbers oflC ex pressin g th e antigeni c markers HLA-DR, -DQ, Human epithelial Langerhans cells (LC) participate in antigen and T6 in les ions of oral HL and in clinica ll y normal oral mucosa processin g in vitro and in vivo and, together with recircul ating from these pati ents. We then examined the relati onship between T lymphocytes and regional lymph nodes, appea r to constitute a th e number of LC and th e presence of vira l antigens and ca ndidal hyphae within the epithelium to fi nd out if changes in LC might be in volved in the pathogenesis of HL. Manuscript received October 20, 1986; accepted fo r publica ti on Feb­ MATERIALS AN D METHODS ruary 11 , 1987. T his work was supported by grants from the Universi ty of Cali fornia Subjects and Biopsy Pa ti ents fo r this study were drawn from Taskforce on AI DS, Fonden til Laegevidenska bens Fre mme, and Novo's a popul at ion previously described [11 and consisted of 23 homo­ Fond . sexual men who had oral HL. All had lesions on the lateral margin Reprint requests to: Troy E. Daniels, D.D.S., School of Dentistry, of the tongue, and one also had lesions 0 11 the buccal mucosa. University of Cali fo rnia, San Francisco, Cali fornia 94143-0424. T he pa ti ents showed evidence of immunodefi ciency, in that T­ Abbreviati ons: lymphocyte helper/suppressor rati os were reduced in all of 13 AIDS: acquired immune defi ciency syndrome patients tes ted (mea n = 0.6, range = 0. 1-1.1) and all of 22 EBV: Epstein-Barr virus HIV: human immunodefi cicncy virus patients tes ted showed absent or reduced delayed hypersensitivity HL: hairy Icukopl aki a skin res ponse to 4 an tigen preparati ons (p urifie d protein deri va­ HPV: human papillomavirus ti ve, Calldida, mumps, and trichophyton). None had AIDS at the LC : Langerhans cell (s) time of diagnosis, but 48% of the pati ents have sin ce developed PAS: periodic acid-Schiff AIDS [13]. 0022-202X/87/S03.S0 Copyright © 1987 by T he Society for Investigati ve Dermatology, Inc. 178 VOL. 89, NO.2 AUG U ST 1987 ORAL H A IRY LEUK OPLAKIA 179 In cisional biopsy specimens were obtain ed fro m each lesion at antigens were dctected by anticomplement indirect immunoflu­ th e time HL was diagnosed. As control tiss ue, clinicall y normal orescence using characteri zed human antisera, and by indirect mucosa from the lateral tonguc posteri or to th e lesions (3 spec­ immunoflu orescence w ith 3 mouse mono clonal antibodies spe­ imens) or from the cheek (9 specimens) were obtained fro m 12 cifi c for EBV viral ca psid antigen, ea rl y antigen-restricted com­ of the patients at thc sa me time as the lesion specimen. Lesion ponent, and earl y antigen-diffusc component, respectively. T hese and control specimens were immedi ately frozen and stored in methods and their controls have been described in detail [1 ,2]. liquid nitrogen until immunohistochemical examinati on. Secti ons Detection of Fungal Hyphae An average of 5 secti ons of 21 stain ed w ith hematoxylin and eosin were prepared fr o m each lesion and 12 control specimens were stained w ith peri odic acid­ specimen. Additional specimens from 9 lesions were prepared for Schiff (PAS) to detect the presence of fungal hyphae within the electron microscopic examinati on by fi xin g in 3% glutaralde­ cpithelium. hyde, postfi xing in 1 % buffe red osmic acid , and embedding in Epon. Statistical Analysis T o determine the statisti cal strength of C ulture specimens were obtained from the oral mucosa of each associati on between the absence of LC and the presence of HPV pati ent befo re biopsy and 15 /23 (65%) revealed the presence of or EBV antigens or fun gal hyphae, we used the Kendall rank Candida albi ca lls. Six of the pati ents were recciving antifungal correlation coeffi cient, a nonparamctric sig nificance tes t for mul­ drugs at the timc of biopsy or in th e weeks preceding biopsy; 2 tiple independent variables. of these had positi ve culture specimens. RES ULT S Detection of Langerhans Cell Antigens Langerhans cell an­ Examination of hematoxylin and eosin-staincd secti ons of the ti gens were detected by immunohistochemistry o n sets of 10-fLm lesions revealed the characteri sti c histopathologic fea tures of HL, thick cryosecti ons cut fr o m each lesion and control specimen, whi ch include acanthosis, irregul ar hyperparakeratosis, areas of whi ch ranged fro m 3-5 mm in width. Sections were pl aced on koilocyti c cell s in the epithelium, and little or no inflammatory formal gelatin-coated slides, fi xed in cold acetone for 10 min, cell infiltration in the subepitheli al connective ti ssue [1 ,2]. The and all owed to air dry. After washing (Tris hydrochloride buffer control secti ons appea red within normal limits, sh owing a very was used for this and all subsequent washes), secti ons were in­ mild subepithelial lymphocyti c infiltra te . cubated in 3% normal horse serum for 20 min at room temper­ In 111 12 (92%) of the control sections, LC were graded as 2 ature, washed again , then incubated in primary antibody for 30 or 3 with at least 2 monoclonal antibodies; in onl y 1 specimen min .
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