Janet E Leigh

Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, United States

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Publications (41)91.77 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: With the support for curriculum change expressed by the American Dental Education Association's Commission on Change and Innovation in Dental Education (ADEA CCI), the Louisiana State University Health Sciences Center School of Dentistry (LSUSD) initiated a course that vertically integrates the basic sciences and clinical sciences and promotes critical thinking. The resulting Dental Rounds course includes presentations by D3 and D4 students on interesting clinical cases, which the entire student body is required to attend. Following the third year of the program, a formal evaluation was conducted, in which surveys were disseminated to students, recent graduates, and faculty members to collect feedback on the efficacy of the course, its perceived value, and its success as an educational tool. Of the 242 students and graduates who were sent surveys, 181 responded, a 74 percent response rate. Of the eighty full-time faculty members, sixty-one responded, a 76 percent response rate. Most respondents reported that the objectives of the course were being achieved, but they identified case-related discussion as an area for strengthening critical thinking skills. As a result, modifications were planned to include formal participation of D1 and D2 students in the presentations, less frequent sessions to accommodate more complete cases, more emphasis on basic science, more structured mentoring, and a modified question format. Dental Rounds was a necessary integration step in dental education for LSUSD, and it is anticipated that the planned modifications will lead to strengthening of critical thinking skills in both students and faculty.
    Journal of dental education 05/2014; 78(5):796-802. · 0.97 Impact Factor
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    K Quimby · EA Lilly · M Zacharek · K McNulty · J E Leigh · J E Vazquez · P L Fidel ·
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    ABSTRACT: Oropharyngeal candidiasis (OPC) is the most common oral infection in HIV(+) persons. Previous studies suggest a role for CD8(+) T cells against OPC when CD4(+) T cells are lost, but enhanced susceptibility to infection occurs when CD8(+) T-cell migration is inhibited by reduced tissue E-cadherin. Objective:  To conduct a longitudinal study of tissue CD8(+) T-cells and E-cadherin expression before, during, and after the episodes of OPC. Oral fungal burden was monitored and tissue was evaluated for CD8(+) T cells and E-cadherin over a 1-year period in HIV(+) persons with a history of, or an acute episode of, OPC. While longitudinal analyses precluded formal interpretations, point prevalence analyses of the data set revealed that when patients experiencing OPC were successfully treated, tissue E-cadherin expression was similar to that in patients who had not experienced OPC, and higher numbers of CD8(+) T cells were distributed throughout OPC(-) tissue under normal expression of E-cadherin. These results suggest that (1) reduction in tissue E-cadherin expression in patients with OPC(+) is not permanent, and (2) high numbers of CD8(+) T cells can be distributed throughout OPC(-) tissue under normal E-cadherin expression. Together, these results extend our previous studies and continue to support a role for CD8(+) T cells in host defense against OPC.
    Oral Diseases 09/2011; 18(2):153-61. DOI:10.1111/j.1601-0825.2011.01856.x · 2.43 Impact Factor
  • M McCullough · L L Patton · M Coogan · P L Fidel · M Komesu · M Ghannoum · J E Leigh ·
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    ABSTRACT: This workshop reviewed aspects of the following: oral fungal disease in HIV-infected patients and the predictive value of oral mucosal disease in HIV progression; the role of the oral biofilms in mucosal disease; microbial virulence factors and the pseudomembranous oral mucosal disease process; the role that oral mucosal disease may have in HIV transmission; and the available topical antifungal treatment. This article summarizes the ensuing discussions and raises pertinent problems and potential research directions associated with oral fungal disease in HIV-infected patients, including the frequency of oral candidosis, the role of the intraoral biofilm in the development of oral mucosal disease, and host-pathogen interactions, as well as the development of the fetal oral mucosa, neonatal nutrition, and the role of oral candidosis in this setting. Finally, discussions are summarized on the use of inexpensive effective antifungal mouthwashes in resource-poor countries, the potential stigmata that may be associated with their use, as well as novel topical medications that may have clinical applicability in managing oral candidal infections in HIV-infected patients.
    Advances in dental research 04/2011; 23(1):152-8. DOI:10.1177/0022034511400912
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    ABSTRACT: Human Papillomavirus-32 (HPV-32) has traditionally been associated with focal-epithelial-hyperplasia (FEH). It is also present in 58% of oral warts of HIV-positive individuals whose prevalence is increasing. Current methods for the detection of HPV-32 are labor-intensive and insensitive so the goal of this work was to develop a highly sensitive and easy to use specific polymerase chain reaction (PCR) assay. An HPV-32 L1 specific PCR assay was developed and optimized. The sensitivity and specificity was compared to previous assays utilized for detection (PGMY and MY09/11 PCR with dot blot hybridization) using cloned HPV-32 L1, the closely related HPV-42 L1 as well as clinical samples (oral swabs and fluids from 89 HIV-positive subjects). The HPV-32 specific PCR assay showed improved sensitivity to 5 copies of HPV-32 as compared to the PGMY PCR, MY09/11 PCR and dot blot which had a limit of detection of approximately 3,000 copies. Using the HPV-32 dot blot hybridization assay as the gold standard, the HPV-32 specific PCR assay has a sensitivity of 95.8% and 88.9% by sample and subject, respectively, and specificity was 87.8% and 58.8% by sample and subject, respectively. The low sensitivity is due to the HPV-32 specific PCR assays ability to detect more HPV-32 positive samples and may be the new gold standard. Due to the ease, sensitivity, and specificity the HPV-32 specific PCR assay is superior to previous assays and is ideal for detection of HPV-32 in large cohorts. This assay provides an excellent tool to study the natural history of HPV-32 infection and the development of oral warts.
    Virology Journal 07/2009; 6(1):90. DOI:10.1186/1743-422X-6-90 · 2.18 Impact Factor
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    ABSTRACT: Oropharyngeal candidiasis (OPC), caused by Candida albicans, is the most common infection in HIV-infected persons. An evaluation of tissue-associated T cells and adhesion molecules in OPC lesions of HIV+ persons with reduced CD4+ T cells showed an accumulation of activated memory CD8+ T cells at the epithelial-lamina propria interface together with reduced expression of E-cadherin. These results suggested a role for CD8+ T cells against OPC, but a dysfunction in the mucosal migration of the cells in those with OPC. Objective: The purpose of the present study was to evaluate changes in tissue-associated CD8+ T cells and E-cadherin expression of HIV+ persons during and after an episode of OPC. Methods: From HIV+ persons with a history of, or an acute episode of OPC, oral fungal burden was evaluated bi-weekly and buccal mucosa tissue was collected bimonthly for a period of one year. Tissue was evaluated for the presence of CD8+ T cells and E-cadherin by immunohistochemistry or flow cytometry. Results: Patients evaluated under OPC- conditions and low oral fungal burden revealed the presence of CD8+ T cells and E-cadherin, but expression was usually unremarkable over time. In situations where OPC- patients had increased oral Candida colonization (indicative of a potential pre-clinical OPC condition), higher numbers of CD8+ T cells were observed throughout the tissue with normal E-cadherin expression. In patients with an acute episode of OPC where CD8+ T cells were accumulated at the epithelial-lamina propria interface together with reduced E-cadherin expression, evaluations following successful treatment revealed normal conditions. Conclusion: These results suggest that under reduced CD4+ T cells, CD8+ T cells typically migrate to the site of a pre-clinical infection under normal expression of E-cadherin and that reduced E-cadherin expression in those with OPC is not permanent. This work was supported by R01DE-12178 from NIDCR.
    IADR General Session 2009; 04/2009
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    ABSTRACT: A landmark report from the U.S. surgeon general identified disparities in oral health care as an urgent and high-priority problem. A parallel development in the dental education community is the growing consensus that significant curriculum reform is long overdue. The authors performed a literature review and conducted a series of structured interviews with key institutional and community stakeholders from seven geographical regions of the United States. They investigated a wide range of partnerships between community-based dental clinics and academic dental institutions. On the basis of their interviews and literature review, the authors identified common themes and made recommendations to the dental community to improve access to care while enhancing the dental curriculum. Reducing disparities in access to oral health care and the need for reform of the dental curriculum may be addressed, in part, by a common solution: strategic partnerships between academic dental institutions and communities. Practice Implications. Organized dentistry and individual practitioners, along with other major stakeholders, can play a significant role in supporting reform of the dental curriculum and improving access to care.
    Journal of the American Dental Association (1939) 11/2007; 138(10):1366-71. DOI:10.14219/jada.archive.2007.0054 · 2.01 Impact Factor

  • Journal of Dental Research 04/2007; 86(3):202-3. DOI:10.1177/154405910708600303 · 4.14 Impact Factor
  • Kishore Shetty · Jorge Garcia · Janet Leigh ·
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    ABSTRACT: This retrospective study evaluated the success rate of root canal therapy in 157 HIV-positive patients who had undergone nonsurgical endodontic treatment in a dedicated clinic between 1998 and 2004. Dental records and radiographs were reviewed and information concerning age, gender, medical history, anti-retroviral medication, treatment dates, and follow-up evaluation was compiled. All root canal treatment was performed following the clinical guidelines of the American Association of Endodontists. A single practitioner who was responsible for seeing all of the patients at the six-month recall examination reviewed radiographs. Success was defined as the absence of pain and swelling as well as the absence of the periapical lesion (or a reduction in size compared to its preoperative radiographic size). At the six-month postoperative evaluation, a success rate of 90% was observed in the study group. No statistically significant differences were noted when the success of the root canal therapy was related to the symptomatic clinical presentation, the antiretroviral therapy, or the viral load.
    General dentistry 11/2006; 54(6):397-402.
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    ABSTRACT: Oropharyngeal candidiasis (OPC) is the most frequently observed oral infection in HIV-infected individuals. Historically, lower CD4 counts have been associated with an increased prevalence of OPC in HIV-infected patients, but HIV viral load has also recently been recognized as a possible predictive factor. We examined the impact of viral load and blood CD4 cell count on the occurrence of OPC using modern exploratory statistical analyses. The exploratory and inferential methods of classification and regression trees (CARTs) and logistic regression were used to compare the impact of viral load and CD4 cell counts on OPC status in 161 HIV-infected individuals from an outpatient clinic population in New Orleans. The use of stepwise logistic regression and CART to classify individual OPC status both identified viral load as the most important covariate, followed by CD4 cells counts. Age, sex, and highly active antiretroviral therapy use were also found to be associated with OPC status. These data strongly suggest that low viral load distinguishes those not at risk for OPC with high viral load, which also includes a heterogeneous set of predictors for OPC status, has the highest impact on OPC classification.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2006; 42(5):578-83. DOI:10.1097/01.qai.0000225011.76439.99 · 4.56 Impact Factor
  • Kishore Shetty · Janet Leigh ·

    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 09/2006; 102(3):327-328. DOI:10.1016/j.tripleo.2006.06.017 · 1.46 Impact Factor
  • EA Lilly · J E Leigh · K M McNulty · S H Joseph · D E Mercante · P L Fidel ·
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    ABSTRACT: In HIV+ persons with reduced CD4+ T cells, oropharyngeal candidiasis (OPC) is often associated with the accumulation of CD8+ T cells at the epithelial/lamina propria interface within the lesion together with increased tissue-associated cytokines and chemokines. Despite this reactivity, a dysfunction in the ability of the CD8+ cells to reach the organism at the outer epithelium is postulated. The purpose of this study was to examine chemokine receptors present in the OPC lesions for a potential role in susceptibility to infection. Biopsies taken from buccal mucosa of HIV- persons, healthy mucosa of HIV+ OPC- persons, and OPC lesions were processed for protein immunohistochemical staining or RNA analysis by real-time PCR and Superarray. There was little change in expression of chemokine receptors at the protein or RNA level between OPC+ and OPC- tissue. At the protein level, increases occurred in OPC+ persons only if associated with CD8 cells. In the Superarray, of the 22 chemokine receptor mRNAs expressed, c. 90% remained unchanged (< 1.0-fold change) between HIV- and HIV+ tissue and between HIV+ OPC- and HIV+ OPC+ tissue. Tissue-associated chemokine receptor expression does not appear to contribute to the dysfunction in cellular migration associated with susceptibility to OPC.
    Oral Diseases 09/2006; 12(5):493-9. DOI:10.1111/j.1601-0825.2006.01226.x · 2.43 Impact Factor
  • E A Lilly · J E Leigh · S H Joseph · P L Fidel ·
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    ABSTRACT: Oropharyngeal candidiasis (OPC), caused by Candida albicans, is the most common oral infection in HIV(+) persons. Oral epithelial cells are considered important for innate host defense against OPC with production of cytokines in response to C. albicans and the ability to inhibit Candida growth in vitro. The purpose of this study was to determine if Candida similarly induces cytokines by oral epithelial cells from HIV(+) persons, including those with OPC, as well as to determine if cytokines can influence the oral epithelial cell anti-Candida activity. Supernatants from oral epithelial cells from HIV(+) persons with and without OPC cultured with Candida were evaluated for cytokines by ELISA, or cytokines were added to the standard growth inhibition assay using epithelial cells from HIV(-) persons. Results showed low Candida-induced epithelial cell cytokine production from HIV(+) persons, but with some elevated proinflammatory cytokines (TNF-alpha, IL-6) in those with OPC compared to those without OPC. The addition of specific proinflammatory or Th cytokines had no effect on oral epithelial cell anti-Candida activity in healthy HIV(-) persons. These results suggest that oral epithelial cells from HIV(+) persons can contribute at some level to the oral cytokine milieu in response to Candida during OPC, but that cytokines do not appear to influence oral epithelial cell anti-Candida activity.
    Mycopathologia 08/2006; 162(1):25-32. DOI:10.1007/s11046-006-0036-7 · 1.53 Impact Factor
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    Janet E Leigh · Kelly M McNulty · Paul L Fidel ·
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    ABSTRACT: Oropharyngeal candidiasis (OPC) remains the most common oral infection in human immunodeficiency virus (HIV) disease. In a high percentage of HIV(+) persons with reduced CD4(+) T cells, oral lesions with Candida present at the outer epithelium have an accumulation of CD8(+) T cells at the epithelium-lamina propria interface associated with reduced expression of the mucosal cell-trafficking adhesion molecule E-cadherin. The purpose of the present study was to characterize the immune status of these CD8(+) T cells. Immunohistochemical staining for phenotypic and activation and costimulation markers was performed on frozen biopsy tissue sections from HIV(+) OPC(+) persons with accumulated CD8(+) T cells. CD8(+) T cells consisted primarily of central memory cells by virtue of positive CD45RO (memory) and CD27 (central memory) expression. However, concomitant negative expression of CD62L and CCR7 (effector memory) was suggestive of a transitioning memory phenotype within the tissue. Despite this, the cells are considered to be activated on the basis of positive expression of CD69. The CD8(+) T cells are not considered to be NK T cells or anti-HIV CD8(+) T cells because of negative or low expression of CD161 and vascular cell adhesion molecule, respectively. These results suggest that the accumulated mucosal migratory-challenged CD8(+) T cells are otherwise normal memory T cells in an activated state.
    Clinical and Vaccine Immunology 07/2006; 13(6):678-83. DOI:10.1128/CVI.00015-06 · 2.47 Impact Factor
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    Kishore Shetty · Janet Leigh ·
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    ABSTRACT: The increases incidence of oral human papillomavirus (HPV) in patients infected with the human immunodeficiency virus (HIV) is of concern and is the focus of numerous current research studies. Recent studies have shown an increased risk of oral warts in HIV-infected individuals despite treatment with highly active antiretroviral therapy (HAART). There seems to be a predilection for the labial mucosa as a site specific for occurrence for oral warts. This reports presents a series of case reports documenting the same observation.
    Oral Oncology Extra 04/2006; 42(4):163-166. DOI:10.1016/j.ooe.2005.10.013
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    ABSTRACT: Prevalence of human papillomavirus (HPV)-associated oral condylomas has reportedly increased in HIV-infected individuals since the introduction of highly active antiretroviral therapy (HAART). The relationships between HIV therapy regimen, overall health, and subclinical oral HPV have not been examined. To determine oral HPV genotype prevalence and the impact of HAART and health in the HIV+ population. An L1 consensus-primer polymerase chain reaction and linear array assay were used to examine the prevalence of 27 HPV genotypes in saliva of 98 HIV+ individuals. Risk assessment variables were compared to oral HPV status. Oral HPV was detected in 37% of HIV+ African American individuals. Caucasians were at greater risk of oral HPV infection than African Americans. Markers of advanced HIV disease did not predict HPV status. Therapy status was associated with HPV detection. Treatment of HIV, rather than HIV immunosuppression, appears to play a role in oral HPV infections in HIV+ individuals.
    Sex Transm Dis 12/2005; 32(11):703-9. DOI:10.1097/01.olq.0000175398.34610.2e · 2.84 Impact Factor
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    Kishore Shetty · Amit Chattopadhyay · Janet Leigh ·
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    ABSTRACT: Recent studies have shown an increased risk of oral warts in HIV+ individuals despite treatment with highly active antiretroviral therapy (HAART). Human papilloma virus (HPV) infection has attracted a great deal of attention, not just because of the difficulty of managing oral warts but also because of the oncogenic potential of certain strains, in particular HPV-16 and -18, which have been detected in 20–30% of oral squamous cell carcinomas. Between 1999 and 2004, DNA extraction was performed using a multiplex PCR reaction to detect and type HPV in 12 HIV-positive adult with a clinicopathologic diagnosis of Oral Warts. HPV was detected in 11 of the 12 orals warts. HPV-32 was present in all subjects, whereas only one subject had a co-infection of HPV-32 and -7. Future studies should examine the specific roles of these specific HPV types and whether a potential link exists for oral premalignant lesions.
    Oral Oncology Extra 11/2005; 41(10):311-315. DOI:10.1016/j.ooe.2005.07.011
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    Kishore Shetty · Janet Leigh ·
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    ABSTRACT: Human papilloma virus (HPV) is the most common sexually transmitted viral disease responsible for mucosal warts and anogenital malignancies. HPV-associated oral lesions include condyloma, focal epithelial hyperplasia and some squamous cell carcinomas. Both oral and genital lesions caused by HPV are more commonly seen in those co-infected with HIV. While there is some degree of HPV genotypespecific clinical presentation, unusual manifestations of oral HPV disease in the HIV-positive patient frequently occur. Examinations of oral-wart biopsy specimens from HIV-positive individuals reveal a range of HPV genotypes, including cutaneous type 2; genital types 6, 11, 16 and 18; and oral type 13. However, the most common HPV genotypes identified in HIV-associated oral warts are oral specific HIV type 32 and the cutaneous HPV type 7. This paper presents two cases of HPV lesions associated with these types, which progressed into oral squamous cell carcinoma.
    Oral Oncology Extra 11/2005; 41(10):272-276. DOI:10.1016/j.ooe.2005.06.013
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    ABSTRACT: Anti-Candida activity by oral epithelial cells is considered one of several innate mucosal defense mechanisms against oropharyngeal candidiasis (OPC). OPC is the most common fungal infection in HIV disease. Previously we reported that oral epithelial cell anti-Candida activity is reduced in those with OPC, potentially representing a contributing factor to OPC. However, testing clinical epithelial cells possessing high levels of Candida has been limiting due to high background in the assay controls. HIV+ smokers often develop OPC sooner than non-smokers during progression to AIDS, suggesting additional immune aberrations. The purpose of this study was to design a means to reduce Candida associated with epithelial cells collected from saliva without affecting their in vitro growth inhibitory activity, and to employ that approach to evaluate antifungal activity in HIV+ smokers. To do so, oral epithelial cells with and without known levels of Candida were subjected to various treatments including azole, polyene, or echinocandin antifungal drugs or fixation followed by the standard growth inhibition (GI) assay. The results indicated that antifungal drugs, while effectively reducing cell-associated Candida, also affected epithelial cell function. In contrast, fixation with paraformaldehyde eliminated cell-associated Candida and had minimal effects on epithelial cell anti-Candida activity. Employing the fixation design that allowed a broad range of patients to be evaluated showed no difference in oral epithelial anti-Candida activity between HIV+ smokers and non-smokers. Therefore, oral epithelial cell antifungal activity does not appear compromised in those who smoke, reducing it as a contributing factor in susceptibility to premature OPC.
    Medical Mycology 10/2005; 43(6):517-23. DOI:10.1080/13693780500050655 · 2.34 Impact Factor
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    ABSTRACT: Oropharyngeal candidiasis (OPC), the most common oral infection in human immunodeficiency virus-positive persons, correlates with reduced blood CD4+ T cells. In those with OPC, CD8+ T cells accumulate at the lamina propria-epithelium interface at a distance from the organism at the outer epithelium. The present study aimed to characterize the tissue-associated CD8+ T cells and tissue microenvironment in both OPC+ and OPC− persons. The results show that the majority of CD8+ T cells possess the αβ T-cell receptor, the thymus-derived αβ CD8 antigen heterodimer, and similar levels of the α4β7, α4β1, and αeβ7 homing receptors. Studies to evaluate the tissue microenvironment showed that in OPC+ persons, the adhesion molecule for T cells to enter mucosa, mucosal addressin cell adhesion molecule, is significantly increased, whereas E-cadherin, which allows T cells to migrate through mucosa, is significantly decreased compared to OPC− persons. These results continue to support a role for CD8+ T cells against OPC under conditions of reduced numbers of CD4+T cells, with susceptibility to infection potentially associated with a dysfunction in mucosal CD8+ T-cell migration by reduced tissue-associated E-cadherin.
    Infection and Immunity 07/2005; 73(6):3659-67. DOI:10.1128/IAI.73.6.3659-3667.2005 · 3.73 Impact Factor
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    ABSTRACT: Oral warts, caused by human papillomavirus (HPV), and oral hairy leukoplakia (OHL) caused by Epstein-Barr virus (EBV), are common oral manifestations in HIV-infected persons. Although both conditions occur most often with reduced blood CD4+ T-cell numbers, oral warts and OHL rarely occur simultaneously, suggesting that dysfunctions in other secondary local immune parameters are also involved. The present study evaluated tissue-associated proinflammatory and T-helper cytokine and chemokine mRNA expression and the presence of T cells in each lesion. Biopsies were taken from lesion-positive and adjacent lesion-negative sites of HIV+ persons with oral warts or OHL and lesion-negative sites from HIV+ persons who were oral HPV or EBV DNA-positive (matched controls). Cytokine/chemokine mRNA expression was quantified by real-time polymerase chain reaction. CD3, CD4, and CD8 cells were identified by immunohistochemistry. No differences were detected in tissue-associated cytokine/chemokine mRNA expression in warts or OHL when compared to lesion-negative sites. Immunohistochemical analysis of T cells showed CD8+ cells exclusively, but few cells were present in either lesion. No differences were detected between lesion-positive and -negative control sites of each pathologic condition. Little evidence was found for local immune reactivity to either oral warts and OHL, suggesting that CD4+ T cells are a primary host defense against both oral warts and OHL, but with nonimmune factors potentially responsible for the divergent prevalence of each.
    Oral Microbiology and Immunology 07/2005; 20(3):154-62. DOI:10.1111/j.1399-302X.2005.00198.x · 2.81 Impact Factor

Publication Stats

652 Citations
91.77 Total Impact Points


  • 2006-2014
    • Louisiana State University Health Sciences Center Shreveport
      Shreveport, Louisiana, United States
  • 2011
    • University of Melbourne
      • Melbourne Dental School
      Melbourne, Victoria, Australia
  • 2002-2011
    • Louisiana State University Health Sciences Center New Orleans
      • • School of Dentistry
      • • Center of Excellence in Oral and Craniofacial Biology Administration
      New Orleans, Louisiana, United States
  • 2005
    • Center For Oral & Maxillofacial Surgery
      Georgia, United States
  • 2003
    • Louisiana State University
      Baton Rouge, Louisiana, United States