Histologic identification of mast cells in human dental pulp

Understanding dental pulp inflammation: from signaling to structure

The pulp is a unique tissue within each tooth that is susceptible to painful inflammation, known as pulpitis, triggered by microbial invasion from carious lesions or trauma that affect many individuals. The host response involves complex immunological processes for pathogen defense and dentin apposition at the site of infection. The interplay of signaling between the immune and non-immune cells via cytokines, chemokines, neuropeptides, proteases, and reactive nitrogen and oxygen species leads to tissue reactions and structural changes in the pulp that escalate beyond a certain threshold to irreversible tissue damage. If left untreated, the inflammation, which is initially localized, can progress to pulpal necrosis, requiring root canal treatment and adversely affecting the prognosis of the tooth. To preserve pulp vitality and dental health, a deeper understanding of the molecular and cellular mechanisms of pulpitis is imperative. In particular, elucidating the links between signaling pathways, clinical symptoms, and spatiotemporal spread is essential to develop novel therapeutic strategies and push the boundaries of vital pulp therapy.

Learned cautions regarding antibody testing in mast cell activation syndrome

OBJECTIVES

To describe patterns observed in antibody titer trendlines in patients with mast cell activation syndrome (MCAS, a prevalent but underrecognized chronic multisystem inflammatory disorder of great clinical heterogeneity) and offer clinical lessons learned from such pattern recognition.

METHODS

The available records of 104 MCAS patients drawn from the authors' practices were reviewed, including all antibody tests therein.

RESULTS

All patients had positive/elevated antibodies of various sorts at various points, but for most of the antibodies which were found to be positive at least some points, the diseases classically associated with those antibodies were not present, marking such antibodies as clinically insignificant mimickers (likely consequent to inflammatory effects of MCAS on the immune system itself driving spurious/random antibody production) rather than "on-target" and pathogenic antibodies reflecting true disease warranting treatment. We also observed two distinct patterns in trendlines of the titers of the mimickers vs. the trendline pattern expected in a true case of an antibody-associated disease (AAD).

CONCLUSIONS

Our observations suggest most positive antibody tests in MCAS patients represent detection of clinically insignificant mimicking antibodies. As such, to reduce incorrect diagnoses of AADs and inappropriate treatment in MCAS patients, caution is warranted in interpreting positive antibody tests in these patients. Except in clinically urgent/emergent situations, patience in determining the trendline of a positive antibody in an MCAS patient, and more carefully assessing whether the AAD is truly present, is to be preferred.

Dental Pulp Inflammation Initiates the Occurrence of Mast Cells Expressing the α1 and β1 Subunits of Soluble Guanylyl Cyclase

The binding of nitric oxide (NO) to heme in the β₁ subunit of soluble guanylyl cyclase (sGC) activates both the heterodimeric α₁β₁ and α₂β₁ isoforms of the enzyme, leading to the increased production of cGMP from GTP. In cultured human mast cells, exogenous NO is able to inhibit mast cell degranulation via NO-cGMP signaling. However, under inflammatory oxidative or nitrosative stress, sGC becomes insensitive to NO. The occurrence of mast cells in healthy and inflamed human tissues and the in vivo expression of the α₁ and β₁ subunits of sGC in human mast cells during inflammation remain largely unresolved and were investigated here. Using peroxidase and double immunohistochemical incubations, no mast cells were found in healthy dental pulp, whereas the inflammation of dental pulp initiated the occurrence of several mast cells expressing the α₁ and β₁ subunits of sGC. Since inflammation-induced oxidative and nitrosative stress oxidizes Fe²⁺ to Fe³⁺ in the β₁ subunit of sGC, leading to the desensitization of sGC to NO, we hypothesize that the NO- and heme-independent pharmacological activation of sGC in mast cells may be considered as a regulatory strategy for mast cell functions in inflamed human dental pulp.

Role of mast cells in inflammatory and reactive pathologies of pulp, periapical area and periodontium

Mast cells (MCs) have been discovered over 130 years ago; their function was almost exclusively linked to allergic affections. At the time being, it is well known that MCs possess a great variety of roles, in both physiologic and pathologic conditions. In the oral tissues, MCs release different pro-inflammatory cytokines and tumor necrosis factor-alpha that promote leukocyte infiltration in various inflammatory states of the oral cavity. These cells play a key role in the inflammatory process and, as a consequence, their number changes in different pathologic conditions of the oral cavity, such as gingivitis and periodontitis. By understanding the role of MCs in the pathogenesis of different inflammatory diseases of the oral cavity, these cells may become therapeutic targets that could possibly improve the prognosis. Therefore, this review summarizes the current understanding of the role of MCs in various inflammatory pulpal, periapical and periodontal pathophysiological conditions.

Synergy of TLR2 and H1R on Cox-2 Activation in Pulpal Cells

Although pulp fibroblasts are a major cell type in dental pulp, their roles in microbial recognition and pulpal inflammation are not well-understood. Considering the pivotal role of Toll-like receptors (TLRs) in the recognition of micro-organisms, we hypothesized that TLRs on pulp fibroblasts may induce inflammatory signals in dental pulp. In human pulp fibroblasts, TLR2, 3, 4, and 5 were constitutively expressed. Stimulation of TLR2 and 3 induced the expression of pro-inflammatory genes such as CXCL10, CCL5, and/or Cox-2 in pulp fibroblasts. Interestingly, histamine synergistically activated TLR2-mediated Cox-2 expression and PGE(2) production. The synergistic effect of histamine is mediated by histamine receptor-1 (H1R). Studies on the intra-cellular signaling pathways revealed that p38 activation is required for the synergistic activation of Cox-2 by TLR2 and histamine. Analysis of these data suggests that TLR2 on pulp fibroblasts, in concert with H1R, can induce an inflammatory response during microbial infection in dental pulp.

Mast cells and lymphocyte subsets in pulps from healthy and carious human teeth

OBJECTIVE

To evaluate the presence of cytolytic T lymphocytes (CD8+), memory T cells (CD45RO+), helper T lymphocytes (CD4+), and mast cells in pulps from healthy and carious human teeth.

STUDY DESIGN

The teeth were separated into groups: I = unerupted; II = partially erupted, without caries; III = erupted, without caries; IV = erupted with shallow dentine caries; and V = teeth with pulp polyps. The immunoperoxidase staining procedure was used to detect CD8, CD45RO, CD4, and tryptase (mast cell marker) antigens. The number of each cell type was obtained by counting the number of cells per mm2.

RESULTS

Mast cells were only present in pulp polyps. Pulps from carious teeth contained more CD4+ and CD8+ cells than from noncarious teeth. There was a significant decrease in the number of lymphocytes in pulp polyps in comparison to the other groups.

CONCLUSIONS

Mast cells probably do not contribute to the early vascular or specific immune responses in the initial dental pulp pathosis, although they may be involved in a chronic phase of pulp inflammation such as pulp polyps. On the other hand, CD4+ and CD8+ T cells participate mainly in initial phenomena of the immune response to incipient caries and seem not to substantially contribute to the response in pulp polyps.

The effect of unilateral sympathectomy and cavity preparation on peptidergic nerves and immune cells in rat dental pulp

Recent evidence suggests interactions between primary afferent nociceptors and postganglionic sympathetic efferents in the pathogenesis of inflammation. The effect of unilateral removal of the superior cervical ganglion on the innervation pattern of nerve fibers immunoreactive (IR) to calcitonin gene-related peptide (CGRP), substance P (SP), and neuropeptide Y (NPY), as well as the occurrence of immune cells in the injured and uninjured rat molar pulp, was investigated. Light microscopic immunocytochemistry demonstrated that the molar pulps contralateral to the sympathectomy contained a NPY-IR nerve fiber network more dense and heavily stained than unoperated control rats. The NPY-IR fibers showed, however, no sprouting after deep cavity preparation. There was no compensatory increase in CGRP- and SP-IR nerve fibers in the dental pulp after unilateral sympathectomy, although a significant increase in cells IR to CGRP and SP was found in the ipsilateral trigeminal ganglion. Unilateral sympathectomy induced a significant increase in immune cell density both in the inflamed and in the uninflamed dental pulp bilaterally. Our results demonstrate, for the first time, a trophic effect of the sympathetic nerves on immune cells in the dental pulp, indicating that an imbalance of sympathetic nerves may induce inflammation and pain in teeth.

Immunoglobulin producing cells in human periapical granulomas

Ten cases of periapical granuloma were stained for igG, IgA, IgM, IgD and IgE by the unlabelled antibody peroxidase-antiperoxidase complex method to investigate the class distribution of plasma cells within the lesions. The results indicated that IgG containing plasma cells predominated in all lesions and that IgG, IgA, IgM, IgE and IgD cells represented 81.9, 11.4, 5.4, 1.1 and 0.2 per cent respectively, of the total positive cell population. All specimens contained IgE plasma cells in addition to many non-lymphoid cells showing membrane-like staining for IgE. The results suggest that in addition to tissue damage via local deposition of immune complexes IgE mediated immediate hypersensitivity reactions may have a role in pathogenesis.