Possible role of apoptosis in the pathogenesis and clinical evolution of radicular cyst: an immunohistochemical study

Effect of calcium hydroxide as intracanal medicament on the expression of caspase-9 located within the radicular cyst epithelium

Apoptosis (a programmed cell death mechanism) within the radicular cyst epithelium has still not been correlated with any clinical factor. This study aimed to investigate the effect of calcium hydroxide on apoptosis, via the detection of caspase-9. Thirty radicular cysts collected during apicoectomies and stored in paraffin were retrospectively retrieved. Conservative endodontic treatments had been carried out either without (group (a) n = 14), or with calcium hydroxide application (group (b), n = 16) before obturation. All cysts were immunohistochemically stained for caspase-9 to record apoptosis of the epithelium. Statistical analysis followed. The frequency of caspase-9 immunoreactivity in the cystic epithelium in the two groups was 42.86% and 93.75% of cysts respectively. This difference was statistically significant (P = 0.04 < 0.05). In cysts larger than (or equal to) 10 mm, caspase-9 was more frequently expressed. It was found calcium hydroxide appears to enhance the expression of caspase-9, especially in large lesions.

Analysis of CD57+ natural killer cells and CD8+ T lymphocytes in periapical granulomas and radicular cysts

The aim of this study was to compare the number of CD57+ natural killer (NK) cells and CD8+ T lymphocytes between periapical granulomas (PGs) and radicular cysts (RCs). Twenty-fives cases of PGs and 25 of RCs were submitted to histological analysis and immunohistochemistry using anti-CD57 and anti-CD8 biomarkers. Positive cells were counted in 10 fields (400× magnification) and the median value was calculated for each case. Statistical tests were used to evaluate differences in the number of CD57+ NK cells and CD8+ T lymphocytes according to type of lesion, intensity of the infiltrate and thickness of the lining epithelium. The number of CD57+ NK cells and CD8+ T lymphocytes was higher in PGs than in RCs (p = 0.129 and p = 0.541, respectively). Comparison of the number of CD57+ NK cells in atrophic and hyperplastic epithelium revealed a larger number of cells in the atrophic epithelium (p = 0.042). A larger number of CD57+ NK cells and CD8+ T lymphocytes were observed in grade III infiltrates compared to grade I/II (p = 0.145 and p = 0.725, respectively). CD8+ T lymphocytes were more prevalent than CD57+ NK cells in most cases when PGs and RCs were analyzed separately or in combination (p < 0.0001). CD57+ NK cells and CD8+ T lymphocytes play a key role in antiviral defense and the presence of these cells supports evidence suggesting the participation of these microorganisms in the pathogenesis of PGs and RCs. The response mediated by CD8+ T lymphocytes was more frequent, indicating greater participation of the adaptive immunity in these chronic lesions.

Toll-like receptor 4 expression in the epithelium of inflammatory periapical lesions. An immunohistochemical study

Toll-like receptors (TLR) are essential for the innate immune response against invading pathogens and have been described in immunocompetent cells of areas affected by periapical disease. Besides initiating the inflammatory response, they also directly regulate epithelial cell proliferation and survival in a variety of settings. This study evaluates the in situ expression of TLR4 in periapical granulomas (PG) and radicular cysts, focusing on the epithelial compartment.

Twenty-one periapical cysts (PC) and 10 PG were analyzed; 7 dentigerous non-inflamed follicular cyst (DC) served as control. TLR4 expression was assessed by immunohistochemistry. TLR4 immunoreaction products were detected in the epithelium of all specimens, with a higher percentage of immunostained cells in PG. Although TLR4 overexpression was detected in both PG and PC, there were differences that seemed to be related to the nature of the lesion, since in PG all epithelial cells of strands, islands and trabeculae were strongly immunoreactive for TLR4, whereas in PC only some areas of the basal and suprabasal epithelial layers were immunostained. This staining pattern is consistent with the action of TLR4: in PG it could promote formation of epithelial cell rests of Malassez and in epithelial strands and islands the enhancement of cell survival, proliferation and migration, whereas in PC TLR4 could protect the lining epithelium from extensive apoptosis. These findings go some way towards answering the intriguing question of why many epithelial strands or islands in PG and the lining epithelium of apical cysts regress after non-surgical endodontic therapy, and suggest that TLR4 plays a key role in the pathobiology of the inflammatory process related to periapical disease.

Radicular Cyst: An Update of the Biological Factors Related to Lining Epithelium

INTRODUCTION

Radicular cysts are common lesions in daily dentistry practice. However, the mechanisms related to epithelial lining formation and cavity growth are not fully understood. Therefore, the purpose of this article was to review the biological factors implicated in these process.

METHODS

Literature was selected through a search of PubMed electronic databases matching the following key words in the title or abstract: "cyst" OR "granuloma" OR "abscess" AND "radicular" OR "apical" OR "periapical" AND "epithelium" OR "epithelial" OR "epithelial lining." The PubMed database was searched for articles published between 1975 and 2014. Only English language was applied to the search.

RESULTS

The literature search yielded a total of 187 articles. After duplicate references were discarded, a subsequent search at the title and abstract level revealed 42 articles for full-text reading. The articles were categorized into 5 main subtopics: (1) cell proliferation, cell cycle, and apoptosis; (2) extracellular matrix constituents; (3) inflammatory components; (4) bone metabolic factors and; (5) others. These subtopics described the characteristics of radicular cysts focusing on the epithelial tissue effects.

CONCLUSIONS

Several factors from different sources (epithelial cells, stromal cells, extracellular matrix, and bone matrix) were implicated on apical cyst pathogenesis. Probably a combination of many factors involving an epithelial-stromal interaction is responsible for the sustenance and growth of apical cysts.

The role of intrinsic pathway in apoptosis activation and progression in Peyronie's disease

Peyronie's disease (PD) is characterized with formation of fibrous plaques which result in penile deformity, pain, and erectile dysfunction. The aim of this study was to investigate the activation of the intrinsic apoptotic pathway in plaques from PD patients. Tunica albuginea from either PD or control patients was assessed for the expression of bax, bcl-2 and caspases 9 and 3 using immunohistochemistry and by measurement of apoptotic cells using TUNEL assay. Bax overexpression was observed in metaplastic bone tissue, in fibroblasts, and in myofibroblast of plaques from PD patients. Little or no bcl-2 immunostaining was detected in samples from either patients or controls. Caspase 3 immunostaining was very strong in fibrous tissue, in metaplasic bone osteocytes, and in primary ossification center osteoblasts. Moderate caspase 9 immunostaining was seen in fibrous cells plaques and in osteocytes and osteoblasts of primary ossification centers from PD patients. Control samples were negative for caspase 9 immunostaining. In PD patients the TUNEL immunoassay showed intense immunostaining of fibroblasts and myofibroblasts, the absence of apoptotic cells in metaplasic bone tissue and on the border between fibrous and metaplastic bone tissue. Apoptosis occurs in stabilized PD plaques and is partly induced by the intrinsic pathway.

Serotonin (5HT) expression in rat pups treated with high-tryptophan diet during fetal and early postnatal development

Serotonin (5HT) is a neurotransmitter synthesized in serotonergic neurons of the central nervous system and in the enterochromaffin cells of the gastrointestinal tract. 5HT regulates growth and maturation of some cerebral regions in the developing brain as well as the secretion of pituitary growth hormone. This hormone is necessary for development and growth through the stimulation of insulin-like growth factor synthesis. The precursor of 5HT, tryptophan (Trp), is an essential amino acid, since the human organism is unable to synthesize it and it is assumed only through diet. The aim of our study was to analyze how a high-tryptophan diet in pregnant rats affects growth and survival of pups until weaning. We monitored the number and weight of pups until weaning. Then, we detected serotonin and growth hormone levels in whole blood by ELISA of surviving pups at the end of the lactation period. We also analyzed by means of immunohistochemistry and Western blot the expression of serotonin in rat gastric tissue and the morphological structure of skeletal muscle tissue of both control and experimental pups. Hyperserotonemia and very low levels of growth hormone were detected in experimental pups compared to controls. Immunohistochemistry demonstrated a strong serotonin expression in stomach samples confirming that a high intake of tryptophan increases the production of serotonin in enterochromaffin cells, thereby resulting in hyperserotonemia in pups. These data were also strengthened by Western blot analysis. Histological alterations of skeletal muscle fibers in experimental pups were found and showed that in experimental samples the muscle tissue demonstrated deleterious alterations, being less developed and defined. Our data suggest that a high-tryptophan diet in pregnant rats induces hyperserotonemia in the fetus. Hyperserotonemia results in an excess of serotonin in the brain where it has a negative influence on development of serotonergic neurons and consequently on growth hormone production.