[Antibody-producing cells in human periapical granulomas and cysts]

IgG4-positive plasma cells are more often detected in chronic periapical lesions arising from permanent rather than primary teeth

AIM

To characterize plasma cell subsets in chronic periapical lesions affecting permanent and primary teeth.

METHODOLOGY

Only chronic periapical lesions without root canal treatment were selected. Twenty-one radicular cysts and 7 periapical granulomas affecting permanent teeth and 19 radicular cysts and 4 periapical granulomas affecting primary teeth were assessed for immunoglobulin (Ig) light chain (kappa and lambda), Ig heavy chain (IgG, IgG4, IgA, IgM and IgD) and plasma cell immunohistochemical markers (MUM1/IRF4, EMA and CD138). The data acquired were analysed by Student's t test, Mann-Whitney U, Friedman test followed by Dunn's multiple comparison test and Spearman's rank correlation.

RESULTS

All cases were polyclonal (having similar kappa/lambda light chain ratios). IgG was most abundant compared to other Ig heavy chains (all, P < 0.001); like Ig light chains, but unlike IgA, there was greater expression of IgG in the primary compared to the permanent dentition, for both radicular cysts (P < 0.001) and periapical granulomas (P = 0.53). Notably, IgG4 expression was greater in the permanent than the primary dentition, for both radicular cyst (P < 0.05) and periapical granuloma (P = 0.65). IgM and IgD expression was scarce and variable, whereas plasma cell populations were detected efficiently through EMA, CD138 and MUM1/IRF4 markers, the latter being more sensitive in both dentitions.

CONCLUSIONS

There were slight variations in the Ig light and heavy chain profiles in chronic periapical lesions when comparing the permanent and primary dentitions. The ability of IgG4+ plasma cell infiltration to modulate inflammatory responses in chronic periapical lesions arising from permanent as opposed to primary teeth should be considered in future studies.

Pathogenesis of apical periodontitis and the causes of endodontic failures

Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. The treatment of apical periodontitis, as a disease of root canal infection, consists of eradicating microbes or substantially reducing the microbial load from the root canal and preventing re-infection by orthograde root filling. The treatment has a remarkably high degree of success. Nevertheless, endodontic treatment can fail. Most failures occur when treatment procedures, mostly of a technical nature, have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful procedures are followed, failures still occur. This is because there are root canal regions that cannot be cleaned and obturated with existing equipments, materials, and techniques, and thus, infection can persist. In very rare cases, there are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The data on the biological causes of endodontic failures are recent and scattered in various journals. This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies.

Flare-ups in endodontics: I. Etiological factors. 1985

A number of hypothetical mechanisms which may be responsible for pain and swelling before and during endodontic therapy are presented. These mechanisms may be interrelated.

Pain in endodontics. 1986

A frequent problem in endodontics is the development of pain and swelling during or after endodontic therapy. Although the reasons for such exacerbations are not always clear, there are a number of hypotheses which will be discussed in this article.

Histological study of the effect of some irrigating solutions on bacterial endotoxin in dogs

The aim of this study was to evaluate, histopathologically, the effectiveness of mechanical preparation of root canals using different irrigating solutions in dog teeth filled with LPS after pulpectomy. A total of 120 root canals of 6 mongrel dogs were filled with a solution of LPS after pulpectomy. The irrigating solutions used were saline, 1, 2.5, and 5% sodium hypochlorite, and 2% chlorhexidine. No irrigation was used in the control group. The animals were sacrificed after 60 days and the teeth were fixed and demineralized. Subsequently, serial 6-µm sections were stained with hematoxylin and eosin and Mallory's trichrome for histopathological analysis and Brown-Brenn for verification of bacterial contamination. Analysis showed that the inflammatory infiltrate was statistically less intense in the groups in which the root canals were irrigated with 5% sodium hypochlorite and 2% chlorhexidine. However, none of the irrigating solutions completely inactivated the harmful effects of LPS. Mechanical preparation associated with different irrigating solutions did not completely inactivate LPS.

Inflammatory infiltrate of chronic periradicular lesions: an immunohistochemical study

AIM

To determine the cellular profile of human chronic periradicular lesions using immunohistochemical methods in order to study the differences in the cell infiltrate of periradicular granulomas and cysts.

METHODOLOGY

The study population consisted of 45 individuals without any systemic disease. Biopsies were obtained during periradicular surgery. Paraffin-embedded sections were stained by the avidin-biotin complex method (ABC), whilst cryostat tissue sections were stained using the alkaline phosphatase antialkaline phosphatase assay (APAAP). These methods are highly valid and sensitive using a panel of specific monoclonal antibodies: CD4, CD8, CD3, CD10, HLADR, CD20, CD45RO, CD68 and CD57. The 45 specimens were characterized by the use of both techniques.

RESULTS

The 45 specimens were histologically diagnosed as: 25 periradicular granulomas, 17 periradicular cysts and 3 scar tissues. No statistically significant differences were detected in the inflammatory infiltrate between periradicular granulomas and cysts. Observation of the sections showed that the majority of inflammatory cells consisted of T and B lymphocytes and macrophages. T and B lymphocytes were equally distributed in 60% of the cases. The T4/T8 ratio ranged approximately from 1 to 3 and greater, being consistent with inflammation of periradicular tissues. The final differentiation of B lymphocytes to plasma cells was also detected, whilst natural killer (NK) cells were found in only 10 cases (22%). Moreover, antigen presenting cells and T suppressor/cytotoxic cells were found to be associated with both pre-existing and newly formed epithelium.

CONCLUSIONS

Periradicular granulomas and cysts represent two different stages in the development of chronic periradicular pathosis as a normal result of the process of immune reactions that cannot be inhibited.

Study of the expression of CD68+ macrophages and CD8+ T cells in human granulomas and periapical cysts

In the periapex, the interaction among inflammatory cells and microorganisms and their products results both in specific and nonspecific immune responses. Many studies have reported quantitative analysis of the immunocompetent cells in periapical lesions, but the exact ratio of these cells in cysts and granulomas remains unknown. In the present study, we undertook a quantitative analysis of CD68+ cells and CD8+ T cells in human periapical granulomas and cysts. Immunoperoxidase staining revealed that CD68+ cells were present in both lesions, with no statistically significant difference, mainly distributed in the inner portion of the lesion, where the inflammation site is more active. On the other hand, CD8+ lymphocytes were more numerous in cysts. Thus, it appears that CD8+ T cells may play a more important role in a later phase of periapical lesion progression, probably exerting regulatory or cytotoxic functions in cellular immune response, which may lead to the stabilization of these lesions.

Protective and destructive immune reactions in apical periodontitis

Apical periodontitis is initiated primarily by the mixed microflora of infected root canals. Continuous flow of bacteria and their products through the apical foramen induces influx, activation and coordinated interaction of immune-inflammatory cells within the periapical area. Successful mobilization of host defense mechanisms prevents abundant extraradicular bacterial invasion. However, anti-infective effector mechanisms are not restricted to killing the invading microorganisms but also destroy normal tissue components and induce bone absorption, resulting ultimately in the loss of the affected teeth. Moreover, autocrine and paracrine loops of stimulation may lead to the perpetuation of the local inflammatory lesion and may also alter the function of remote tissues and organs. This review attempts to summarize current knowledge about the pathogenic mechanism of apical periodontitis, focusing on the formation of a special granulation tissue that effectively fights bacteria originated from the infected pulp chamber and, by exerting this protective function, also contributes to harmful local and distant events. The dynamic equilibrium between defensive and destructive mechanisms may provide a pathobiological basis for better understanding of clinical signs and symptoms of various forms of apical periodontitis lesions and influence treatment strategy and practice.

The preparation of periapical lesions for flow cytometry

AIM

To devise an optimal protocol and to analyse the leucocyte composition of periapical (PA) lesions by flow cytometry.

METHODOLOGY

PA lesions were mechanically agitated, with and without proteolysis. This was with either 0.2% collagenase alone, or in combination with 0.02% DNA-ase in serial incubations until all tissue was digested. The efficacy of each method was assessed by counting total cell yield and cell viability. Phenotype stability was gauged by the percentage of peripheral blood leucocytes (PBL) which expressed CD45RB, CD3, CD20, CD4 and CD8 before and after mechanical and collagenase treatment.

RESULTS

Disaggregation of PA lesions was superior if collagenase was present, but cell clumping was problematic unless the DNA-ase was also added, and serial digestion with this combination produced optimal cell yield and viability. Nevertheless, the total number of cells released rarely exceeded 105, though viability was in excess of 80%. Mechanical agitation and proteolysis adversely affected PBL phenotypes, but collagenase digestion limited to 10 min caused least damage. Flow cytometric analysis of disaggregated PA lesions failed to identify more than 7.9% (mean, range 6-10%) CD45RB + cells.

CONCLUSIONS

Because of the necessity for single cell suspensions, flow cytometry is not easily applied to the analysis of leucocytes in PA lesions, and further refinements in tissue disaggregation and cell preparation are required.

Relative distribution of plasma cells expressing immunoglobulin G subclass mRNA in human dental periapical lesions using in situ hybridization

Immunoglobulin G (IgG)-producing plasma cells are the predominant immunoglobulin secreting plasma cells in human dental periapical lesions, compared with immunoglobulin A- and immunoglobulin M-producing plasma cells. In this study, the cells expressing mRNA, that encoded the distinct IgG subclasses, were detected using an in situ hybridization technique in 25 periapical lesions. These lesions consisted of 14 periapical granulomas and 11 radicular cysts. Four oligonucleotide probes were chemically synthesized from IgG subclass-specific hinge region genes to ensure specificity of the probes. Plasma cells expressing mRNA, which coded for the IgG subclasses, were detected in formalin-fixed/paraffin wax-embedded sections. Background staining was negligible in all of the sections tested. The in situ hybridization method used in this study was both specific and sensitive for the detection of mRNA encoding each of the four distinct IgG subclasses, whereas the cells retained good morphology. The relative proportions of plasma cells expressing each of the IgG subclass-specific mRNAs in both granulomas and cysts were as follows: IgG1 (57.4 and 55.5%); IgG2 (34.1 and 34.6%); IgG3 (4.0 and 4.3%); and IgG4 (4.0 and 5.5%). There were no significant differences between the percentages of plasma cells expressing each of the IgG subclass mRNAs between the two types of lesions. IgG1 producing plasma cells comprised the highest proportion of IgG-producing plasma cells in both types of periapical lesion. IgG2-producing plasma cells were next in abundance, followed by plasma cells for either IgG3 or IgG4, which were in roughly equivalent numbers.

Increased susceptibility of RAG-2 SCID mice to dissemination of endodontic infections

Specific immunity has been implicated in the pathogenesis of periapical lesions, although the extent to which these mechanisms are actually involved in either protection or destruction of the pulp-periapex complex is yet to be established. To investigate this question we compared periapical-lesion pathogenesis in RAG-2 severe combined immunodeficient (SCID) mice with immunocompetent control mice following surgical pulp exposure. In order to equalize the bacterial challenge, an infection protocol using Prevotella intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, and Streptococcus intermedius was devised. The results demonstrated that after infection, the proportion of the root canal flora represented by the four pathogens was almost identical in both groups (39.9 and 42.2% for RAG-2 and immunocompetent control mice, respectively). The effects of abrogation of T- and B-cell mechanisms on periapical pathogenesis were then assessed. Approximately one-third of the RAG-2 mice developed endodontic abscesses, while no immunocompetent controls had abscesses, results which indicated regional dissemination of the infection. A similar incidence of abscesses was found in two additional experiments. Abscessed RAG-2 teeth had significantly larger periapical lesions than did nonabscessed RAG-2 teeth (P < or = 0.05) and exposed immunocompetent controls (P < or = 0.01), whereas nonabscessed RAG-2 teeth were not significantly different from those of exposed immunocompetent controls in periapical-lesion size. We conclude that B- and T-cell-mediated immunity protects the host from the dissemination of endodontic infections and that RAG-2 mice are more susceptible to infection-induced pulp-periapex destruction.

Analysis of immunoglobulin-synthesizing cells in human dental periapical lesions by in situ hybridization and immunohistochemistry

Immunoglobulin (Ig) kappa (kappa) and lambda (lambda) light chain mRNA-expressing cells were investigated by in situ hybridization (ISH) to assess the local humoral immune response in human dental periapical lesions. Twenty-seven biopsy samples (17 periapical granulomas and 10 radicular cysts) were examined. Both types of light chain mRNA-positive cells were detected in formalin-fixed/paraffin-embedded tissue sections in all samples. Plasma cells showed weak to strong cytoplasmic staining with both probes and background staining was negligible. The ISH methodology is specific and sensitive in detecting Ig light chain mRNAs and retains cell morphology well. kappa to lambda ratios showed moderate variability for both granulomas and cysts (mean = 1.66 +/- 0.85 SD, 1.47 +/- 0.51, respectively). There was no significant difference in light chain distribution between granulomas and cysts. Ig kappa and lambda light chain proteins were also studied by immunohistochemistry (IHC) but the results were disappointing due to excessive background staining. This study confirms that Ig is locally produced in periapical lesions and that the ISH method localises Ig light chain-containing cells better than IHC. The wide variability in kappa/lambda ratio may support the concept of non-specific multibacterial infection in these lesions.

Effect of T-cell deficiency on the formation of periapical lesions in mice: histological comparison between periapical lesion formation in BALB/c and BALB/c nu/nu mice

The role of T-cells in the development of periapical lesions was investigated immunohistochemically using 16 normal (BALB/c) mice and 16 nude (BALB/c nu/nu) mice (congenitally T-cell-deficient mice). The pulp chambers of maxillar first molars of all mice were opened, and the infiltrated immunocytes (anti-Thy1.2, -Lyt-1, -Lyt-2, -L3T4, -I-Ad, -IgG, and -IgM positive cells) were determined immunohistochemically at 2, 4, 6, and 8 wk after operation. Periapical lesions appeared at 2 wk in both mouse groups. Numerous anti-I-Ad positive-stained cells appeared at 2 wk, anti-I-Ad, -Thy1.2 (-Lyt-1, -L3T4), -IgG positive-stained cells appeared between 4 and 8 wk, and periapical lesions with bone resorption rapidly increased until 4 wk in normal mice. On the other hand in nude mice, only anti-I-Ad and -IgG positive cells were present from 4 to 6 wk, and the progress of periapical lesions with inflammatory cells stopped at 6 wk. Furthermore, numerous fibroblasts were found instead of inflammatory cells at 8 wk. These findings suggest that the progression of periapical lesions with bone resorption required helper T-cells and numerous immunoglobulin-producing cells.

Local prophylactic benadryl injections in an attempt to reduce postinstrumental pain

This study was done to determine the clinical efficacy of a 15-mg diphenhydremine hydrochloride (Benadryl) local injection as a prophylactic treatment in the prevention of pain resulting from initial instrumentation of necrotic teeth. A double-blind study comprised of 37 subjects, each with one nonvital maxillary tooth, was completed in which patients were divided into two equal groups. The experimental group received a local anesthetic of 3% Carbocaine, followed by an additional injection of the antihistamine. The control group received the local anesthetic and an equivalent quantity of sterile saline. Patients recorded their pain levels at various time intervals: preoperatively, immediately postoperatively, and at 3, 7, 12, and 24 h postoperatively. Graphic analysis using a Quatro-Pro spread sheet program showed that there were no significant differences between the groups pain scores. However, there was a correlation between pain and time elapsed after procedure. In both groups, postoperative pain appeared to increase from 3 to 7 h and decrease from 7 to 24 h.

Presence of secretory IgA in human periapical lesions

The concentration of secretory IgA in fluids present in the canals of 33 teeth was determined by the rocket immunoelectrophoresis technique. Except for the presence or absence of communication between the oral cavity and the root canals of the affected teeth, no other clinical finding showed significant statistical correlation with the presence of secretory IgA. The canals which were open to the oral flora had significantly higher concentrations of secretory IgA. Leaving canals open to the oral cavity may result in formation of periapical cysts.

Distribution of Ia antigen-expressing nonlymphoid cells in various stages of induced periapical lesions in rat molars

Periapical lesions were experimentally produced in rat lower first molars by exposing the pulp to the oral environment for 1 to 56 days. Temporal changes in the number and distribution of la antigen-expressing nonlymphoid cells in the periapical tissue were examined immunohistochemically on decalcified cryostat sections using OX6, a monoclonal antibody against rat la antigen. Influx of la-positive exudative cells into the periapical tissue was observed from 1 day postoperatively. Between 14 and 28 days when expansion of the periapical lesion was most evident, numerous la-positive macrophage-like and dendritic cell-like cells of diverse morphologies were found in the periapical tissue. The number of these cells showed further increase at 56 days postoperatively, when the lesion expansion had ceased. These results suggest the involvement of la antigen-expressing nonlymphoid cells in the development and perpetuation of periapical pathosis. They may act primarily as antigen-presenting cells, which are essential for the initiation of antigen-specific immune defense.

Quantitative analysis of immunocompetent cells in human periapical lesions: Correlations with clinical findings of the involved teeth

Human periapical lesions develop as a result of a pathological immune response to continuous stimuli from infected root canals. This study identified the immunocompetent cells in such lesions immunohistochemically and quantified them to examine their interrelationships and correlations with clinical findings. The number of IgG-containing cells in CD4+ cell (Th/i)-rich lesions (> or = 55 CD4+ cells/2 x 10(4) microns 2) was significantly larger than in CD4+ cell-poor lesions (< 55 CD4+ cells/2 x 10(4) microns 2). This indicated that the CD4+ cells and the IgG-containing cells acted together against antigenic stimuli. The proportion of T cells in the mononuclear infiltrates varied with the size of the periapical lesions. The proportion of CD11+ cells (monocytes/macrophages) was significantly larger in lesions which showed a positive reaction to percussion or were tender on palpation than in the lesions without these symptoms. These observations suggest that T cells may play an important role in the development of periapical lesions and that CD11+ cells may be involved in the development of symptoms.

Comparative immunohistochemical identification and relative distribution of immunocompetent cells in sections of frozen or formalin-fixed tissue from human periapical inflammatory lesions

The presence of immunocompetent cells (B, Th/i and Ts/c cells and macrophages) and the ratios of these cell populations in periapical lesions (radicular granulomas, radicular cysts and apical scars) were demonstrated immunohistochemically using paraffin and cryo-sections. Thirty-four human periapical lesions were examined for the presence of immunocompetent cells by monoclonal antibodies and the biotin-avidin-horseradish peroxidase method. The T/B cell ratio of radicular cysts was significantly higher than that of both radicular granulomas and apical scars, and the average number of Th/i cells was greater than that of Ts/c cells in the radicular granulomas. However, no significant difference was found between radicular cyst and apical scar. The number of macrophages in radicular granulomas was significantly higher than that of the other lesions. These findings suggested that periapical lesions develop as a result of both humoral and cell-mediated immunological response and indicated that the ratios of immunocompetent cells are different in the different types of periapical lesion.

Serum IgG reactive with oral anaerobic microorganisms associated with infections of endodontic origin

Numerous species of bacteria have been implicated with infections of endodontic origin. The purpose of this study was to compare the levels of serum IgG antibodies reactive with a panel of 10 oral anaerobic microorganisms implicated in infections of endodontic origin. Serum samples were collected from 4 patient groups that included healthy patients without endodontic or periodontal disease, patients with chronic adult periodontal disease, patients with endodontic disease and patients with combined endodontic-periodontal disease. When Prevotella intermedia was allowed to react with sera from the 4 patient groups, significant pairwise differences were shown between the healthy group and each of the other 3 groups. In addition, there was a significant difference between the periodontal disease group and the combined endodontic-periodontal disease group. When Porphyromonas gingivalis was allowed to react with sera from the 4 patient groups, significant pairwise differences were shown between the healthy group and the periodontal disease group, the healthy group and the combined endodontic-periodontal disease group, the endodontic disease group and the periodontal disease group and the endodontic disease group and the combined endodontic-periodontal disease group. The results of this investigation support other studies that associate P. intermedia with both endodontic disease and chronic adult periodontal disease. The results also support studies that implicate P. gingivalis as a periodontopathogen.

A new view of prostaglandin E regulation of the immune response

Prostaglandins, particularly those of the E series, are widely regarded as immunosuppressive products of eukaryotic cells that can downregulate many aspects of B- and T-cell function. In this article, Richard Phipps and colleagues present a different concept of E series prostaglandins, based on recent evidence supporting a role for prostaglandins as potentiators of immunoglobulin class switching and of the synthesis of selected cytokines and cytokine receptors.

Light and ultrastructural studies of human chronic periapical lesions

Forty clinically chronic periapical granulomas and cysts and their corresponding teeth were removed. Diagnosis was by light and transmission electron microscopy. Ultrastructural features of the root surfaces concerned and the corresponding soft tissue were detected by scanning electron microscopy. Chronic periapical inflammation had caused root resorption which affected the cementum and/or the dentin. There were no ultrastructural differences between granuloma- and cyst-induced root resorption. Resorption lacunae were devoid of epithelial and connective tissue attachment. However, root surface exposed to granulomas and cysts also indicated spontaneous cementum repair. Moreover, at their periphery, cellular debris, cells defined as fibroblasts, and cell projections and fibrils could be seen which were continuations of the periodontal ligament.

Quantitative significance of IgE-producing plasma cells and tissue distribution of mast cells in apical periodontitis

A total of 30 dental periapical lesions were used for estimating the frequency of IgE-producing plasma cells by the unlabelled antibody peroxidase antiperoxidase method. Mast cells were detected in adjacent sections by the naphthol-AS-D-chloroacetate esterase technique. IgE-producing plasma cells were present in the central granulation tissue in 26 of the 30 specimens. The average ratio of IgE-containing plasma cells was 0.22% as related to all plasma cells. The central granulation tissue was devoid of mast cells, but numerous mast cells were found in the fibrous capsule of periapical lesions.

Differentiation of T lymphocyte subpopulations, macrophages, and HLA-DR-restricted cells of apical granulation tissue

Sixteen specimens excised from apical granulation tissue were examined for immunocompetent T lymphocytes, mononuclear phagocytes, and HLA-DR-determined cells. Light microscopic visualization of the cells was performed using monoclonal antibodies and the immunocytochemical alkaline phosphatase anti-alkaline phosphatase technique. Quantitative assessment of the biopsy specimens showed that in five diagnosed cysts, eight granulomas, and three specimens taken from scar tissue, macrophages represented the dominating inflammatory cell fraction, followed by T lymphocytes. In the latter group, helper/inducer T cells were most frequent. Cysts showed a statistically significant increase in cell populations of helper/inducer, suppressor/cytotoxic T cells, macrophages, and HLA-DR-coded cells. There were only a few activated T lymphocytes.

Complement activation as a possible in vitro indication of the inflammatory potential of endodontic materials

Samples of four brands of gutta-percha and the nine ingredients that make up one brand were studied in vitro to observe their interaction with the serum complement system, thus allowing for assessment of their possible inflammatory potential. Crossed immunoelectrophoresis of the third complement component was used as an indicator of complement activation. The four different brands of gutta-percha showed comparable complement activation as determined by C3 conversion. When the ingredients of one brand of gutta-percha were examined for complement-activating properties, major activities were associated with gutta-percha compound, agerite stalite-antioxidant, and titanium oxide food grade. The significance of the possible inflammatory potential of gutta-percha and its ingredients, as it relates to endodontic therapy, is discussed.

Immunocytochemical examination of immune cells in periapical granulomata and odontogenic cysts

Monoclonal antibodies (mAbs) were used to determine the presence and distribution of immune cells including lymphocytes, macrophages and Langerhans cells, in normal periodontal ligament, periapical granulomata, periapical cysts and dental developmental cysts. Isolated T-lymphocytes, but not B-lymphocytes, were detected in specimens of non-inflamed periodontal ligament. Increased numbers of T and B lymphocytes were found in all of the lesions examined. Monocytes/macrophages were associated with most periapical granulomata, dental developmental cysts and all periapical cysts. Langerhans cells, intraepithelial lymphocytes, and monocytes/macrophages were not detected in the rests of Malassez but were found in some epithelia within periapical granulomata and in most epithelial linings of odontogenic cysts. Increased numbers of immune cells were seen around proliferative epithelia and adjacent to the epithelial linings of cysts. Epithelium, particularly that of odontogenic cysts, showed positive reactions for HLA-Dr, lysozyme and for alpha-1 antitrypsin. The presence of immune cells in periapical granulomata and odontogenic cysts, suggests that cell-mediated and humoral immunoreactions occur in these lesions and may be associated with the epithelial proliferation within the periapical lesions.

Quantification and analysis of the glycosaminoglycans in human odontogenic cyst linings

Glycosaminoglycans (GAG) were extracted from the connective tissue of 15 dental cysts, 2 dentigerous cysts and 7 keratocysts, and separated electrophoretically and chromatographically. Hyaluronic acid (dental, 2.38; dentigerous, 3.98; keratocyst, 3.19 micrograms uronic acid/mg lyophilized tissue) was the major GAG detected, with lesser amounts of heparin (dental, 1.70; dentigerous, 1.95; keratocyst, 1.80 micrograms uronic acid/mg lyophilized tissue) and chrondroitin-4-sulphate (dental, 1.33; dentigerous, 2.85; keratocyst, 1.37 micrograms uronic acid/mg lyophilized tissue). It is suggested that enzymic release of these GAGs allows their diffusion into the luminal fluid where they may contribute to expansile cyst growth.

In situ characterization of cells in periapical granuloma by monoclonal antibodies

Monoclonal antibodies were used in histopathologic and immunohistologic studies of periapical granulomas. In cellular zones, plasma cells and lymphocytes predominated, with variable numbers of fibroblasts, macrophages, and polymorphonuclear leukocytes. Labeling with monoclonal antibodies disclosed relatively infrequent, usually scattered macrophages. Plasma cells were numerous and frequently clumped. The vast majority of lymphocytes were T cells, scattered individually or in small groups of three or four cells and dispersed throughout the granulomas without any topographic predilection, with prevalence of T-suppressor/cytotoxic cells over T-helper/inducer cells. Our findings of numerous plasma cells, which were in agreement with descriptions of numerous immunoglobulin-producing cells by other authors, imply the participation of antibody-mediated immune reactions in periapical granulomas. The presence of cell-mediated immunity, in spite of numerous T cells, could not be confirmed.

Immunoglobulin-producing cells in human odontogenic cysts

Immunohistochemical staining of immunoglobulin-containing plasma cells was performed on odontogenic keratocysts, dental (periapical) and dentigerous cysts. IgG-containing plasma cells were the predominant species in all cyst types examined, with a much lower percentage of IgA- and few IgM-containing plasma cells. Statistically significant differences in the percentage contributions of IgG and IgA plasma cells were observed between the keratocyst and both the dental (periapical) and dentigerous cysts and for IgM between the keratocyst and dental (periapical) cyst. Intense extracellular staining was observed for IgG in all cyst types.

Cells infiltrating human periapical inflammatory lesions

Cells infiltrating human periapical granulomas and cysts were analyzed using cell suspensions. Over 50% of the total cells studied were lymphocytes whilst neutrophils were the next most frequent cell type observed. Two percent of the cells were mast cells. Only a few monocytes/macrophages and natural killer cells were found. More than half of the lymphocytes infiltrating the lesions were T cells, and more than half of the T cells were of the suppressor/cytotoxic (OKT8) phenotype. The OKT4/OKT8 ratio was 0.5. The findings are compared to previous reports and the differences discussed.

Monoclonal and oligoclonal immunoglobulins localized in human dental periapical lesion

The gamma-globulin fractions of extracts obtained from 70 periapical lesions were studied by agarose gel electrophoresis and immunofixation. In agarose gel electrophoresis, homogeneous bands in the gamma-globulin region were found in 25 of 70 specimens (36%). Among the 25 specimens showing homogeneous bands, these bands in six specimens were identified as monoclonal or oligoclonal immunoglobulins. Local production of oligoclonal immunoglobulins was suggested since the corresponding homogeneous bands were not detected in the serum of the same patient. These immunoglobulins may be produced as a result of local immunogenic response against infecting bacteria in periapical inflammation.

In situ characterization of mononuclear cells in human dental periapical inflammatory lesions using monoclonal antibodies

Mononuclear cells in cryostat sections of human dental periapical inflammatory lesions were studied with the aid of murine monoclonal antibodies and with indirect immunofluorescence microscopy. T lymphocytes (OKT3-positive cells) made up a major part of the cells in the infiltrates. They were found mainly in clusters, although single cells were also seen. T helper cells (OKT4) were more numerous than suppressor/cytotoxic T cells (OKT8-positive cells), with a ratio of approximately 2:1. Langerhans cells (OKT6-positive cells) were not demonstrated: only a few scattered HNK 1-positive cells, probably natural killer cells, were detected. A large number of OKM1- and OKIa 1-positive cells were detected in the infiltrates. Their size and number varied considerably in the different areas of the sections. These cells are probably macrophages. Sheets of small OKIa 1-positive cells were also demonstrated, indicating the presence of B lymphocytes or activated T lymphocytes. The results indicate that immune reactions may be of importance in the pathogenesis of periapical inflammatory lesions.

Deposits of immunoglobulins and complement factor C3 in human dental periapical inflammatory lesions

Thirty-five human dental periapical lesions were studied by immunofluorescence technique using polyclonal anti-IgG (F(ab)2), anti-IgM (F(ab)2), anti-IgA (F(ab)2), anti-IgE and anti-C3c as well as monoclonal anti-IgE. Prewashed ethanol-fixed specimens showed a great number of plasma cells staining for IgG. Cells containing IgA, IgM or IgE were also seen. Deposits of immunoglobulins and C3c suggestive of immune complexes were demonstrated using a double staining technique combining FITC-labeled immunoglobulins with TRITC-conjugated C3c. The complexes were located intracellularly in macrophages, as well as in vessel walls and in the basement membrane zone of proliferating epithelium. Immune complexes may be involved in the epithelial proliferation in those granulomas which lead to cyst formation. Monoclonal anti-IgE demonstrated plasma cells and mast cells, as well as intercellular IgE in epithelial strands of granulomas. The role of IgE in the epithelium is obscure. The study strongly indicates the involvement of hypersensitivity reactions type I and III in periapical inflammatory lesions.

Isolation and characterization of inflammatory cells from the human periapical granuloma

Twelve histologically-confirmed periapical granulomas were evaluated by conventional immunologic rosette assays for the presence of T-lymphocytes and complement receptor-bearing lymphocytes. A technique for dispersing the granuloma cells into suspensions was adopted to facilitate performance of the assays which were not applicable to tissue sections. Differential cell counts by an acridine orange vital dye method disclosed that the cell suspensions contained 30% macrophages, 44% lymphocytes, 15% plasma cells, and 12% neutrophils. Complement receptor-bearing cells comprised 17.9%, and T cells comprised 34.5% of the unseparated inflammatory cells. This study provides the first direct evidence of a predominance of thymic-derived lymphocytes in the lymphocyte compartment of the periapical granuloma. Analysis of the data shows that cell-mediated immunity most likely plays a role in the pathogenesis of the periapical granuloma.