Twist expression in dentigerous cyst, odontogenic keratocyst, and ameloblastoma

Differential expression of the epithelial mesenchymal transition factors Snail, Slug, Twist, TGF-β, and E-cadherin in ameloblastoma

Epithelial mesenchymal transition (EMT), the transition of epithelial cells into motile mesenchymal cells, plays an important role in embryogenesis, cancer invasion, and metastasis. Ameloblastomas are common epithelial odontogenic tumors, occurring exclusively in the mandible with locally invasive growth. Thirty-seven ameloblastoma cases were evaluated for the involvement of EMT by immunohistochemical staining and western blotting using antibodies against Slug, Snail, Twist, TGF-β, and E-cadherin. Double immunostaining was also performed. Slug and TGF-β were expressed in the nuclei of peripheral and stellate reticulum cells of ameloblastoma nests. Twenty cases of Snail, 36 of Slug, 8 of Twist, and 19 of TGF-β showed strong expression in tumor cells in follicular and plexiform patterns. Expression of Slug and TGF-β increased in regions where the expression of E-cadherin was reduced. EMT was found to be associated with the local invasive growth of ameloblastoma. These data suggest that reduced expression of E-cadherin and over-expression of Slug, Snail, and TGF-β induce EMT. Given that ameloblastomas are characterized by local invasiveness, EMT might be related to their development. Thus, strong expression of Slug and TGF-β and reduced expression of E-cadherin might be related to the local invasiveness of ameloblastoma.

Immunohistochemical biomarkers in ameloblastomas

Ameloblastoma is an aggressive odontogenic tumour, which is locally invasive and highly recurrent. Studies show that ameloblastoma is a benign odontogenic neoplasia, being relatively rare and occasionally presenting behaviour of malignant lesions. In addition to these particularities, the histological diagnosis of ameloblastoma can be challenging when the tumour shows high rates of mitosis, absence of nuclear pleomorphism, basilar hyperplasia and neural invasion. In order to help in the diagnosis, prognosis and treatment of this neoplasia, some immunohistochemical markers were shown to be associated with tumoural epithelium. The identification of these markers as well as of their association with clinical signs can be useful to elaborate more efficient treatment strategies and to control this pathology, including improvement of the quality of life of patients affected by this neoplasia. This article aims to review some markers associated with specific molecular pathways, bone remodelling, cell proliferation, apoptosis, cell signalling and tumour suppression.

Twist and Snail expression in tumor and stromal cells of epithelial odontogenic tumors

BACKGROUND

The aims of this study were to evaluate expression of Twist and Snail in tumor and stromal cells of epithelial odontogenic tumors and to analyze relationships between Twist and Snail expression and between tumor and stromal expression.

METHODS

Immunohistochemistry was performed using Twist and Snail antibodies in 60 ameloblastomas (AMs; 20 solid/multicystic, 20 unicystic, and 20 recurrent), six ameloblastic carcinomas (ACs), 10 adenomatoid odontogenic tumors (AOTs), and six calcifying epithelial odontogenic tumors (CEOTs).

RESULTS

A higher rate of tumor cells strongly positive for Twist was observed in AC compared to the other tumors (P = 0.019). The rate of tumor cells strongly positive for Snail tended to be higher in AC than in AM (P = 0.060). AM and AC showed a higher rate of Twist-positive stromal cells than AOT and CEOT (P < 0.001). Tumor cells of recurrent AM showed stronger expression of Twist (P < 0.001) and Snail (P = 0.001) compared to AM without recurrence. A moderate positive correlation was observed between tumor expression of Twist and Snail (r = 0.376, P = 0.001) and between tumor and stromal expression of Snail (r = 0.334, P = 0.002).

CONCLUSIONS

Twist and Snail may affect the epithelial-mesenchymal transition in AC and be involved in recurrence of AM. Stromal Twist expression may be associated with aggressive clinical behavior of epithelial odontogenic tumors. A Twist-Snail pathway may participate in the development and progression of odontogenic tumors, and tumor-stroma interaction in odontogenic tumors may be mediated by Snail.