Información de la revista
Vol. 100. Núm. 8.
Páginas 669-684 (octubre 2009)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 100. Núm. 8.
Páginas 669-684 (octubre 2009)
Practical dermatology
Acceso a texto completo
Oral Leukoplakia: Clinical, Histopathologic, and Molecular Features and Therapeutic Approach
La Leucoplasia Oral: Definición de Parámetros Clínicos, Histopatológicos y Moleculares y Actitud Terapéutica
Visitas
19724
A. Martorell-Calatayuda,
Autor para correspondencia
antmarto@hotmail.com

Correspondencia: Antonio Martorell Calatayud, C/ San José de la Montaña, n.° 14, puerta 11,` 46008 Valencia, Spain.
, R. Botella-Estradaa, J.V. Bagán-Sebastiánb, O. Sanmartín-Jiméneza, C. Guillén-Baronaa
a Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
b Servicio de Estomatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Abstract

Dermatology departments are currently seeing an increase in the number of cases of oral diseases. Of note among the range of lesions covered by this broad area of knowledge is oral leukoplakia—the most common precancerous lesion and the most problematic in terms of both diagnosis and therapeutic management.

In addition to defining leukoplakia, this review also establishes a differential diagnosis with the other most important oral diseases and analyzes the different clinical, histologic, and molecular features that can provide an indication of the risk of malignant transformation. Finally, a therapeutic algorithm is presented to help us optimize clinical management of the disease.

Key words:
leukoplakia
tobacco
therapy
risk of transformation
Resumen

Actualmente existe un incremento del número de casos de patología oral en los servicios de Dermatología. Dentro de las diversas lesiones que forman parte de esta amplia área de conocimiento destacamos la leucoplasia oral, por ser la lesión mucosa precancerosa más frecuente y la que mayores problemas origina tanto en su diagnóstico como en su manejo terapéutico. En esta revisión, además de definir la leucoplasia, establecemos un diagnóstico diferencial con el resto de las patologías orales más importantes y analizamos los diversos parámetros clínicos, histológicos y moleculares que definen el riesgo de transformación maligna de esta patología. Finalmente se establece un algoritmo terapéutico que nos ayuda a optimizar su manejo clínico.

Palabras clave:
leucoplasia
tabaco
terapia
riesgo de transformación
El Texto completo está disponible en PDF
References
[1.]
R.T. Greenlee, T. Murray, S. Bolden, P.A. Wingo.
Cancer statistics, 2000.
CA Cancer J Clin, 50 (2000), pp. 7-33
[2.]
J. Paricio-Rubio, J. Revenga-Arranz, T. Ramírez-Gasca, P. Boned-Blas.
Leucoqueratosis nicotínica del paladar.
Actas Dermosifiliogr, 93 (2002), pp. 38-41
[3.]
S.K. Mithani, W.K. Mydlarz, F.L. Grumbine, I.M. Smith, J.A. Califano.
Molecular genetics of premalignant oral lesions.
[4.]
S.M. Lippman, W.K. Hong.
Molecular markers of the risk of oral cancer.
N Engl J Med, 344 (2001), pp. 1323-1326
[5.]
J.J. Pindborg, P. Reichart, C.J. Smith, I. Van der Waal.
World Health Organization: histological typing of cancer and precancer of the oral mucosa.
Springer-Verlag, (1997),
[6.]
J. Sudbø, A. Reith.
The evolution of predictive oncology and molecular-based therapy for oral cancer prevention.
Int J Cancer, 115 (2005), pp. 339-345
[7.]
J. Bánoczy, Z. Gintner, C. Dombi.
Tobacco use and oral leucoplakia.
J Dental Educ, 65 (2001), pp. 322-327
[8.]
J.E. Bouquot, L.H. Weiland, L.T. Kurland.
Leucoplakia and carcinoma in situ synchronously associated with invasive oral/oropharyngeal carcinoma in Rochester, Minn, 1935-1984.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 65 (1998), pp. 199-207
[9.]
K.K.H. Gundlach.
Wieviele plattenepthelkarzinome der mundhöhle sind aus leukoplakien enstanden?.
Dtch Z Mundokierfer-gesichts-Chir, 16 (1992), pp. 109-111
[10.]
K. Schepman, E.H. van der Meij, l. Smeele, I. van derl Waal.
Concomitant leucoplakia in patients with oral squamous cell carcinoma.
Oral Dis, 5 (1999), pp. 206-209
[11.]
K.O. Duncan, J.K. Geisse, D.J. Leffel.
Epidermal and appendageal tumors.
Fitzpatrick's Dermatology in general medicine, 7th ed., pp. 1024-1026
[12.]
J.J. Pindborg, J. Reibel, B. Roed-Petersn, F.S. Mehta.
Tobacco-induced changes in oral leukoplakic epithelium.
Cancer, 45 (1980), pp. 2330-2336
[13.]
A. Jepsen, J.E. Winther.
Mycotic infection in oral leukoplakia.
Acta Ondontol Scand, 23 (1965), pp. 239-256
[14.]
G. Renstrup.
Occurrence of candida in oral leukoplakias.
Acta Pathol Microbiol Scand [B] Microbiol Immunol, 78 (1970), pp. 421-424
[15.]
J. Reibel.
Prognosis of oral pre-malignant lesions: significance of clinical, histopathological, and molecular biological characteristics.
Crit Rev Oral Biol Med, 14 (2003), pp. 47-62
[16.]
H. Nielsen, B. Norrild, P. Vedtofte, F. Praetorius, J. Reibel, P. Holmstrup.
Human papillomavirus in oral premalignant lesions.
Eur J Cancer B Oral Oncol, 32 (1996), pp. 264-270
[17.]
F. Praetorius.
HPV-associated diseases of oral mucosa.
Clin Dermatol, 15 (1997), pp. 299-413
[18.]
C.S. Miller, B.M. Johnstone.
Human papillomavirus as a risk factor for oral squamous cell carcinoma: a metaanalysis, 1982-1997.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 91 (2001), pp. 622-635
[19.]
G. D'Souza, A.R. Kreimer, R. Viscidi, M. Pawlita, C. Fakhry, W.M. Koch, et al.
Case-control study of human papillomavirus and oropharyngeal cancer.
N Engl J Med, 356 (2007), pp. 1944-1956
[20.]
J.V. Bagán, Y. Jiménez, J. Murillo, C. Gavaldá, R. Poveda, C. Scully, et al.
Lack of association between proliferative verrucous leukoplakia and human papillomavirus infection.
J Oral Maxillofac Surg, 65 (2007), pp. 46-49
[21.]
J.V. Bagán, Y. Jiménez, J. Murillo, R. Poveda, J.M. Díaz, C. Gavaldá, et al.
Epstein-Barr virus in oral proliferative verrucous leukoplakia and squamous cell carcinoma: A preliminary study.
Med Oral Patol Oral Cir Bucal, 13 (2008), pp. E110-E113
[22.]
M.J. Renan.
How many mutations are required for tumorigenesis? Implications for human cancer data.
Mol Carcinog, 7 (1993), pp. 139-146
[23.]
L. Zhang, M.P. Rosin.
Loss of heterozygosity: a potential tool in management of oral premalignant lesions?.
J Oral Pathol Med, 30 (2001), pp. 513-520
[24.]
J. Sudbø, S.M. Lippman, J.J. Lee, L. Mao, W. Kildal, A. Sudbø, et al.
The influence of resection and aneuploidy on mortality in oral leukoplakia.
N Engl J Med, 350 (2004), pp. 1405-1413
[25.]
L. Zhang, C.F. Poh, W.L. Lam, J.B. Epstein, X. Cheng, X. Zhang, et al.
Impact of localized treatment in reducing risk of progression of low-grade oral dysplasia: molecular evidence of incomplete resection.
Oral Oncol, 37 (2001), pp. 505-512
[26.]
Curfman GD, Morrissey S, Drazen JM. Retraction of: “Sudbø J et al. DNA content as a prognostic marker inpatients with oral leukoplakia. N Engl J Med. 2001;344:1270-8 and Sudbø J et al. The influence of resection and aneuploidy on mortality in oral leukoplakia. N Engl J Med2004;350:1405-13.” N Engl J Med. 2006;355:1927.
[27.]
M.S. Greenblatt, W.P. Bennet, M. Hollstein, C.C. Harris.
Mutations in the p53 tumor suppressor gene: clues to cancer etiology and molecular pathogenesis.
Cancer Res, 54 (1994), pp. 4855-4878
[28.]
S. Warnakulasuriya.
p53 and oral precancer – a review.
Oral oncology, pp. 93-96
[29.]
I.B. Cruz, P.J. Snijders, C.J. Meijer, B.J. Braakhuis, G.B. Snow, J.M. Walboomers, et al.
P53 expression above the basal cell layer in oral mucosa is an early event of malignant transformation and has predictive value for developing oral squamous cell carcinoma.
[30.]
L. Poeta, J. Manola, M.A. Goldwasser, A. Forastiere, N. Benoit, J.A. Califano, et al.
TP53 mutations and survival in squamouscell carcinoma of the head and neck.
N Engl J Med, 357 (2007), pp. 2552-2561
[31.]
B. Luzar, M. Poljak, I.J. Marin, A. Eberlinc, U. Klopcic, N. Gale.
Human telomerase catalytic subunit gene re-expression is an early event in oral carcinogenesis.
Histopathology, 45 (2004), pp. 13-19
[32.]
V. Ravn, E. Dabelsteen.
Tissue distribution of histo-blood group antigens.
APMIS, 108 (2000), pp. 1-28
[33.]
E. Dabelsteen.
ABO blood group antigens in oral mucosa. What is new?.
J Oral Pathol Med, 31 (2002), pp. 65-70
[34.]
A.G. Banerjee, I. Bhattacharyya, J.K. Vishwanatha.
Identification of genes and molecular pathways involved in the progression of premalignant oral epithelia.
Mol Cancer Ther, 4 (2005), pp. 865-875
[35.]
E. Dabelsteen, B. Gron, U. Mandel, I. Mackenzie.
Altered expression of epithelial cell surface glycoconjugates and intermediate filaments at the margins of mucosal wounds.
J Invest Dermatol, 111 (1998), pp. 592-597
[36.]
P.R. Morgan, I.M. Leigh, P.E. Purkis, I.D. Gardner, G.N.P. van Muijen, E.B. Lane.
Site variation of keratin expression in human oral epithelia-an immunocytochemical study on individual keratins.
Epithelia, 1 (1987), pp. 33-43
[37.]
B.K. Bloor, S.V. Seddon, P.R. Morga.
Gene expression of differentiation-specific keratins in oral epithelial dysplasia and squamous cell carcinoma.
Oral Oncol, 37 (2001), pp. 251-261
[38.]
S. Hamidi, T. Salo, T. Kainulainen, J. Epstein, K. Lerner, H. Larjava.
Expression of alpha(v)beta 6 integrin in oral leukoplakia.
Br J Cancer, 82 (2000), pp. 1433-1440
[39.]
M.Y. Kuo, S.J. Cheng, H.M. Chen, S.H. Kok, L.J. Hahn, C.P. Chiang.
Expression of CD44s, CD44v5, CD44v6 and CD44v7-8in betel quid chewing-associated oral premalignant lesions and squamous cell carcinomas in Taiwan.
J Oral Pathol Med, 27 (1998), pp. 428-433
[40.]
H. Sunaga, S. Fujieda, H. Tsuzuki, K. Asamoto, M. Fukuda, H. Saito.
Expression of granulocyte colony stimulating factor receptor and platelet-derived endothelial cell growth factor in oral and oropharyngeal precancerous lesions.
Anticancer Res, 21 (2001), pp. 2901-2906
[41.]
M. Sirinivasan, S.D. Jewell.
Evaluation of TGF-and EFGR expression in oral leukoplakia and oral submucous fibrosis by quantitative immunohistochemistry.
Oral Oncol, 61 (2001), pp. 284-292
[42.]
S. Soni, J. Kaur, A. Kumar, N. Chakravarti, M. Mathur, S. Bahadur, et al.
Alterations of Rb pathway components are frequent events in patients with oral epithelial dysplasia and predict clinical outcome in patients with squamous cell carcinoma.
Oncology, 68 (2005), pp. 314-325
[43.]
J.G. Izzo, V.A. Papadimitrakopoulou, X.Q. Li, H. Ibarquen, J.S. Lee, J.Y. Ro, et al.
Dysregulated cyclin D1 expression early in head and neck tumorigenesis: In vivo evidence for an association with subsequent gene amplification.
Oncogene, 17 (1998), pp. 2313-2322
[44.]
R.C. Jordan, M. Macabeo-Ong, C.H. Shiboski, N. Dekker, D.G. Ginzinger, D.T. Wong, et al.
Overexpression of matrix metalloproteinase-1 and -9 mRNA is associated with progression of oral dysplasia to cancer.
Clin Cancer Res, 10 (2004), pp. 6460-6465
[45.]
N. Vigneswaran, S. Beckers, S. Waigel, J. Mensah, J. Wu, J. Mo, et al.
Increased EMMPRIN (CD147) expression during oral carcinogenesis.
Exp Mol Pathol, 80 (2006), pp. 147-159
[46.]
S. Arora, J. Kaur, C. Sharma, M. Mathur, S. Bahadur, N.K. Shukla, et al.
Stromelysin 3, Ets-1, and vascular endothelial growth factor expression in oral precancerous and cancerous lesions: correlation with microvessel density, progression and prognosis.
Clin Cancer Res, 11 (2005), pp. 2272-2284
[47.]
T. Axéll, J.J. Pindborg, C.J. Smith, I. van der Waal.
Oral white lesions with special reference to precancerous and tobaccorelated lesions: conclusions of an international symposium held in Uppsala, Sweden, May 18-21 1994. International Collaborative Group on Oral White Lesions.
J Oral Pathol Med, 25 (1996), pp. 49-54
[48.]
S. Silverman Jr, M. Gorsky, F. Lozada.
Oral leukoplakia and malignant transformation. A follow up study of 257 patients.
Cancer, 53 (1984), pp. 563-568
[49.]
P.O. Lind.
Malignant transformation in oral leucoplakia.
Scand J Dent Res, 95 (1987), pp. 449-455
[50.]
P.C. Gupta, R.B. Bhonsle, P.R. Murti, D.K. Daftary, F.S. Mehta, J.J. Pindborg.
An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia.
Cancer, 63 (1989), pp. 2247-2252
[51.]
L.S. Hansen, J.A. Olson, S.J. Silverman.
Proliferative verrucous leukoplakia. A long-term study of thirty patients.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 60 (1985), pp. 285-298
[52.]
S. Silverman Jr, M. Gorsky.
Proliferative verrucous leukoplakia: a follow up study of 54 cases.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 84 (1968), pp. 154-157
[53.]
P.J. Slootweg, H. Müller.
Verrucous hyperplasia or verrucous carcinoma. An analysis of 27 patients.
J Maxillofac Surg, 11 (1983), pp. 13-19
[54.]
I.R. Kramer, N. el-Labban, K.W. Lee.
The clinical features and risk of malignant transformation in sublingual keratosis.
Nr Dent J, 144 (1978), pp. 171-180
[55.]
C.A. Lesh, C.A. Squier, A. Cruchley, D.M. Williams, P. Speight.
The permeability of human oral mucosa and skin to water.
J Dent Res, 68 (1989), pp. 1345-1349
[56.]
J.J. Sciubba.
Oral leukoplakia.
Crit Rev Oral Biol Med, 6 (1995), pp. 147-160
[57.]
F.S. Mehta, J.J. Pindborg, P.C. Gupta, D.K. Daftary.
Epidemiologic and histologic study of oral cancer and leucoplasia among 50,915 villagers in India.
Cancer, 24 (1996), pp. 832-849
[58.]
J. Bánóczy, A. Csiba.
Occurrence of epithelial dysplasia in oral leukoplakia. Analysis and follow-up study of 12 cases.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 42 (1976), pp. 766-774
[59.]
C.A. Waldron, W.G. Shafer.
Leucoplakia revisited. A clinicopathologic study 3256 oral leukoplakias.
Cancer, 36 (1975), pp. 1386-1392
[60.]
S. Silverman, K. Bhargava, L.W. Smith, A.M. Malaowalla.
Malignant transformation and natural history of oral leucoplakia in 57,518 workers on Gujarat, India.
Cancer, 38 (1976), pp. 563-568
[61.]
S. Silverman Jr, M. Gorsky, F. Lozada.
Leucoplakia, dysplasia and malignant transformation.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 82 (1996), pp. 117
[62.]
K.P. Schepman, E.H. van der Meij, L.E. Smeele, I. van del Waal.
Malignant transformation of oral leukoplakia: a follow up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands.
Oral Oncol, 34 (1998), pp. 270-275
[63.]
D.J. Brothwell, D.W. Lewis, G. Bradley, I. Leong, R.C. Jordan, D. Mock, et al.
Observer agreement in the grading of oral epithelial dysplasia.
Community Dent Oral Epidemiol, 31 (2003), pp. 300-305
[64.]
H.H. Mincer, S.A. Coleman, K.P. Hopkins.
Observations on the clinical characteristics of oral lesions showing histologic epithelial dysplasia.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 33 (1972), pp. 389-399
[65.]
J. Bánóczy.
Follow up studies in oral leukoplakia.
J Maxillofac Surg, 5 (1977), pp. 69-75
[66.]
P.C. Gupta, F.S. Mehta, D.K. Daftary, J.J. Pindborg, R.B. Bhonsle, P.N. Jalnawalla, et al.
Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow up study of Indian villagers.
Community Dent Oral Epidemiol, 6 (1980), pp. 283-333
[67.]
C.G. Cowan, T.A. Gregg, S.S. Napier, S.M. McKenna, F. Kee.
Potentially malignant oral lesions in northern Ireland: a 20-year population-based perspective of malignant transformation.
Oral Dis, 7 (2001), pp. 18-24
[68.]
E. Natarajan, S.B. Woo.
Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity.
J Am Acad Dermatol, 58 (2008), pp. 151-157
[69.]
A.C. Chi, P.R. Lambert 3rd, Y. Pan, R. Li, D.T. Vo, E. Edwards, et al.
Is alveolar ridge keratosis a true leukoplakia?: A clinicopathologic comparison of 2,153 lesions.
J Am Dent Assoc, 138 (2007), pp. 641-651
[70.]
G. Lodi, A. Sardella, C. Bez, F. Demarosi, A. Carrassi.
Interventions for treating oral leukoplakia.
Cochrane Database Syst Rev, (2006),
[71.]
M. Brennan, C.A. Migliorati, P.B. Lockhart, D. Wray, I. Al-Hashimi, T. Axéll, et al.
Management of oral epithelial dysplasia: a review.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 103 (2007), pp. S19
[72.]
J.J. Lee, W.K. Hong, W.N. Hittelman, L. Mao, R. Lotan, D.M. Shin, et al.
Treatment and prevention of intraepithelial neoplasia: an important target for accelerated new agent development.
Clin Cancer Res, 8 (2002), pp. 314-346
[73.]
J.S. Lee, V.M. Papadimitrakopoulou, C. Geyer, C. Perez, J.W. Martin, A.K. El-Naggar, et al.
Predicting cancer development in oral leukoplakia: ten years of translational research.
Clin Cancer Res, 6 (2000), pp. 1702-1710
[74.]
B.J. Braakhuis, M.P. Tabor, J.A. Kummer, C.R. Leemans, R.H. Brakenhoff.
A genetic explanation of Slaughter's concept of field cancerization: evidence and clinical implications.
Cancer Res, 63 (2003), pp. 1727-1730
[75.]
M.B. Sporn, N. Suh.
Chemoprevention: an essential approach to controlling cancer.
Nat Rev Cancer, (2002), pp. 537-543
[76.]
J. Sudbø, A. Ristimäki, J.E. Sondresen, W. Kildal, M. Boysen, H.S. Koppang, et al.
Cyclooxigenasae-2 (COX-2) expression in high risk premalignant lessions.
Oral Oncol, 39 (2003), pp. 497-505
[77.]
S. Han, J. Roman.
Suppression of prostaglandin E2 receptor subtype EP2 by PPAR-gamma ligand inhibits human lung carcinoma cell growth.
Biochem Biophys Res Commun, 314 (2004), pp. 1093-1099
[78.]
R.O. Pomerantz, I.R. Grandis.
The role of epidermal growth factor receptor in head and neck squamous cell carcinoma.
Curr Oncol Rep, 5 (2003), pp. 140-146
[79.]
L.D. Ke, K. Adler-Storthz, G.L. Clayman, A.W. Yung, Z. Chen.
Differential expression of epidermal growth factor receptor inhuman head and neck cancers.
Head Neck, 20 (1998), pp. 320-327
[80.]
I.R. Grandis, D.I. Tweardy.
Elevated levels of transforming growth factor alpha and epidermal growth factor receptor messenger RNA are early maskers of carcinogenesis in head and neck cancer.
Cancer Res, 53 (1993), pp. 3579-3584
[81.]
J. Rubin Grandis, D.J. Tweardy, M.F. Melhern.
Asynchronous modulation of transforming growth factor alpha and epidermal growth factor receptor protein expression in progression of premalignant lesions to head and neck squamous cell carcinoma.
Clin Cancer Res, 4 (1998), pp. 13-20
[82.]
F.C. Holsinger, D.D. Doan, S.A. Jasser, E.A. Swan, J.S. Greenberg, B.A. Schiff, et al.
Epidermal growth factor receptor blockade potentiates apoptosis mediated by Paclitaxel and leads for prolonged survival in a murine model of oral cancer.
Clin Cancer Res, 9 (2003), pp. 3183-3189
[83.]
C.I. Torrance, P.E. Jackson, E. Montgomery, K.W. Kinzler, B. Vogelstein, A. Wissner, et al.
Combinatorial chemoprevention of intestinal neoplasia.
Nat Med, 6 (2000), pp. 1024-1028
[84.]
T.I. Maier, K. Schilling, R. Schmidt, O. Geisslinger, S. Grosch.
Cyclooxygenase-2 (COX-2)-dependent and -independent anticarcinogenic effects of celecoxib in human colon carcinoma cells.
Biochem Pharmacol, 67 (2004), pp. 1469-1478
[85.]
E.M. Boon, J.I. Keller, T.A. Wormhoudt, F.M. Giardiello, G.J. Offerhaus, R. van der Neut, et al.
Sulindac targets nuclear beta-catenin accumulation and Wnt signalling in adenomas of patients with familial adenomatous polyposis and in human colorectal cancer cell lines.
Br J Cancer, 90 (2004), pp. 224-229
[86.]
C. Han, J. Leng, A.J. Demetris, T. Wu.
Cyclooxygenase-2 promotes human cholangiocarcinoma growth: evidence forcyclooxygenase-2-independent mechanism in celecoxibmediated induction of p21waf1/cip1 and p27kip1 and cell cycle arrest.
Cancer Res, 64 (2004), pp. 1369-1376
[87.]
S.K. Kulp, Y.T. Yang, C.C. Hung, K.F. Chen, J.P. Lai, P.H. Tseng, et al.
3-phosphoinositide-dependent protein kinase l/Akt signaling represents a major cyclooxygenase-2-independent target for celecoxib in prostate cancer cells.
Cancer Res, 64 (2004), pp. 1444-1451
[88.]
F.A. Sinicrope.
Targeting cyclooxygenase-2 for prevention and therapy of colorectal cancer.
Mol Carcinog, 45 (2006), pp. 447-454
[89.]
C.E. Clay, G.I. Atsumi, K.P. High, F.H. Chilton.
Early de novo gene expression is required for 15-deoxy-Delta 12, 14-prostaglandin J2-induced apoptosis in breast cancer cells.
J Biol Chem, 276 (2001), pp. 47131-47135
[90.]
J.M. Lehmann, J.M. Lenhard, B.B. Oliver, G.M. Ringold, S.A. Kliewer.
Peroxisome proliferator-activated receptors alpha and gamma are activated by indomethacin and other non-steroidal anti-inflammatory drugs.
J Biol Chem, 272 (1997), pp. 3406-3410
Copyright © 2009. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Descargar PDF
Idiomas
Actas Dermo-Sifiliográficas
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?