Detection of epidermal growth factor receptor in inflammatory periapical lesions

About a Possible Impact of Endodontic Infections by Fusobacterium nucleatum or Porphyromonas gingivalis on Oral Carcinogenesis: A Literature Overview

Periodontitis is linked to the onset and progression of oral squamous cell carcinoma (OSCC), an epidemiologically frequent and clinically aggressive malignancy. In this context, Fusobacterium (F.) nucleatum and Porphyromonas (P.) gingivalis, two bacteria that cause periodontitis, are found in OSCC tissues as well as in oral premalignant lesions, where they exert pro-tumorigenic activities. Since the two bacteria are present also in endodontic diseases, playing a role in their pathogenesis, here we analyze the literature searching for information on the impact that endodontic infection by P. gingivalis or F. nucleatum could have on cellular and molecular events involved in oral carcinogenesis. Results from the reviewed papers indicate that infection by P. gingivalis and/or F. nucleatum triggers the production of inflammatory cytokines and growth factors in dental pulp cells or periodontal cells, affecting the survival, proliferation, invasion, and differentiation of OSCC cells. In addition, the two bacteria and the cytokines they induce halt the differentiation and stimulate the proliferation and invasion of stem cells populating the dental pulp or the periodontium. Although most of the literature confutes the possibility that bacteria-induced endodontic inflammatory diseases could impact on oral carcinogenesis, the papers we have analyzed and discussed herein recommend further investigations on this topic.

Expression of epithelial growth factors and of apoptosis-regulating proteins, and presence of CD57+ cells in the development of inflammatory periapical lesions

The mechanisms that stimulate the proliferation of epithelial cells in inflammatory periapical lesions are not completely understood and the literature suggests that changes in the balance between apoptosis and immunity regulation appear to influence this process.

Immunohistochemical analysis of ADAMTS-1, versican and pEGFR expressions in periapical granuloma and radicular cyst

Background

ADAMTS expression can be associated with several inflammatory processes, and has been correlated with tumorigenesis of some neoplasms, but its participation in the development of periapical lesions has not been investigated. Therefore, our objective was to verify the expression of ADAMTS-1, versican and pEGFR in Periapical Granuloma (PG) and in the Radicular Cyst (RC) since they are the most common lesions of the periapex.

Methods

25 samples of RC and 10 of PG were used. As a control, 10 samples of inflammatory fibrous hyperplasia (IFH) and 10 of dental follicle (DF) were used. The expression of these proteins was investigated using immunohistochemistry.

Results

In the epithelium of RC, IFH and DF, the expression of ADAMTS-1 was greater in DF than in RC (p < .001). Versicano showed greater expression in IFH than in RC, DF than in RC (p < .001). pEGFR showed greater expression in IFH and RC than in DF (p < .01 and p < .05, respectively). In connective tissue, ADAMTS-1 expression was greater in PG and RC than in IFH and DF (p < .001). Versicano showed greater expression in PG, RC and IFH compared to DF (p < .001). In pEGFR there was a higher expression in PG when compared to RC, IFH and DF (p < .001). Greater immunostaining occurred in the RC than in the DF (p < .001).

Conclusions

Our results suggest that the studied proteins may participate in the pathogenesis of PG and RC, through the interaction of these proteins, in the remodeling of the ECM (versican) by ADAMTS-1, producing bioactive fragments, which could activate EGFR, contributing to the formation, growth and maintenance of injuries.

Stem Cell Marker Expression in Persistent Apical Periodontitis

INTRODUCTION

This study evaluated the expression of CD90 (mesenchymal stem cell) and Sox2 (progenitor stem cell) markers in persistent apical periodontitis (PAP) (n = 16) and primary periapical lesions (PPLs) (n = 10).

METHODS

All samples were classified histologically according to the intensity of inflammatory cell infiltrate in the periapical lesion. Immunohistochemistry was used to detect CD90 and Sox2 in PAP and PPLs. The Spearman correlation coefficient and the Mann-Whitney U test were used to analyze data at the 5% significance level.

RESULTS

CD90 expression was found in mesenchymal cells and vascular endothelial cells of 68.5% of all cases of PAP. There was no correlation between CD90 expression and histopathological diagnosis (P = .053) or inflammatory cell infiltrate intensity (P = .112). CD90 staining was predominantly found in the vascular endothelial cells of 30% (n = 3) of PPLs. CD90 expression was significantly higher in PAP than in PPLs (Mann-Whitney U test, P < .05). Sox2 expression was found in all cases of PAP. Eventually, all mesenchymal and chronic inflammatory cells exhibited Sox2 expression. There was no correlation between Sox2 expression and histopathological diagnoses (P = .749), inflammatory cell infiltrate intensity (P = .510), or acute or chronic inflammatory cell infiltrate (P = .256). Sox2 expression was found in 100% of PPLs. There was no difference in Sox2 expression between PAP and PPLs (P = .477).

CONCLUSIONS

Mesenchymal stem cells may contribute to the immunosuppressive environment in PAP. Additionally, distinct stem cell sources may be associated with the chronic nature of PAP as well as with the development of PPLs.

Effects of epidermal growth factor and/or nerve growth factor on Malassez's epithelial rest cells in vitro: expression of mRNA for osteopontin, bone morphogenetic protein 2 and vascular endothelial growth factor

BACKGROUND AND OBJECTIVE

Malassez's epithelial rest (MER) cells are involved in the maintenance and homeostasis of the periodontal ligament (PDL). The purpose of this study was to determine the effects of epidermal growth factor (EGF) and/or nerve growth factor (NGF) in vitro on these functions of MER cells.

MATERIAL AND METHODS

MER cells from porcine PDL were incubated for 3 or 9 h after the addition of EGF and/or NGF to final concentrations of 10 ng/mL. Cells cultured without those growth factors were used as controls. The expression of mRNA for osteopontin, bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF) was analyzed using quantitative RT-PCR.

RESULTS

There was a decrease in the expression of osteopontin mRNA by MER cells treated for 9 h with NGF and the level of mRNA expressed was lower than that of the control and EGF-treated groups. The expression of BMP-2 mRNA by MER cells treated with NGF for 9 h also decreased, and was lower than that of the control and EGF-treated groups. The expression of VEGF mRNA by MER cells treated with EGF for 3 or 9 h was higher than in the control and NGF-treated groups. The expression of VEGF mRNA was lower in MER cells treated with NGF for 3 and 9 h than in the control and EGF-treated groups, and decreased from 3 to 9 h of treatment. EGF stimulated MER cells to secrete VEGF, which suggests that EGF plays an important role in maintaining the homeostasis of the PDL. NGF acts on MER cells to inhibit calcification in the PDL. Furthermore, in the EGF+NGF-treated MER cells, expression of mRNA for BMP-2 and VEGF was similar to that of the NGF-treated group, but cell proliferation and expression of osteopontin mRNA were similar to that of the EGF-treated group.

CONCLUSION

EGF and NGF play important roles in maintaining the PDL.

Assessment of vascularity as an index of angiogenesis in periradicular granulomas. Comparison with oral carcinomas and normal tissue counterparts

AIM

To quantify vascularity in periradicular granulomas using different endothelial markers, and assess its value as an index of angiogenesis by comparing granulomas with healthy periodontal ligament (PDL). To use oral tumours, compared with adjacent normal mucosa, as positive controls.

METHODOLOGY

Paraffin-embedded sections were stained with antibodies to von Willebrand factor (vWF), a pan-endothelial marker, and CD105, a putative marker for angiogenic vessels. Vascularity was quantified by different methods reflecting vessel volume and density.

RESULTS

Irrespective of the marker or method used, vascularity values were similar in periradicular granuloma and PDL. Both tissues were highly vascularized, with levels similar to those found in oral squamous cell carcinoma. Vascularity was significantly higher in the latter than in normal mucosa. Fewer vessels were positive for CD105 than for vWF in the normal mucosa, whereas similar numbers were found in the other tissues examined.

CONCLUSIONS

A comparison of vascularity in oral tumours and normal oral mucosa provided evidence of angiogenesis in the former. Staining with CD105 added limited value to staining with vWF in these tissues. In contrast, a comparison of periradicular granuloma and PDL failed to demonstrate evidence of angiogenesis in the granuloma. As all vessels were similarly stained with vWF and CD105 in granuloma and PDL, a possible hypothesis is that all vessels are newly formed in these tissues. A more plausible alternative is that CD105 expression may reflect the metabolic activity or intrinsic characteristics of the tissues, rather than the presence of angiogenic vessels.

Experimental evidence supports the abscess theory of development of radicular cysts

OBJECTIVE

The objective of this study was to experimentally induce inflammatory cysts in an animal model so as to test the hypothesis that radicular cysts develop via the "abscess pathway."

METHODOLOGY

Twenty-eight perforated custom-made Teflon cages were surgically implanted into defined locations in the back of 7 Sprague Dawley rats. A week after the implantation of the cages, a known quantity of freshly grown, close allogeneic oral keratinocytes in phosphate buffer solution (PBS) was injected into each cage. One cage per animal was treated as the control that received only epithelial cells. The remaining 3 cages of each animal were trials. Seven days post epithelial cell inoculation; a suspension of 0.2 mL of Fusobacterium nucleatum (10(8) bacteria per mL) was injected into each of the 3 trial cages. Two, 12, and 24 weeks after the inoculation of the bacteria, the cages were taken out, and the tissue contents were fixed and processed by correlative light and transmission electron microscopy. Sixteen of the 21 trial cages could be processed and yielded results.

RESULTS

Inoculations of epithelial cells followed 1 week later by F. nucleatum into tissue cages resulted in the development inflammatory cysts in 2 of the 16 cages. The 2 cages contained a total of 4 cystic sites. None of the control cages showed the presence of any cyst-like pathology.

CONCLUSIONS

Inflammatory cysts were induced by initiating acute inflammatory foci (abscess/necrotic area) by bacterial injection that got enclosed by a proliferating epithelium. This finding provides strong experimental evidence in support of the "abscess theory" of development of radicular cysts.

The epithelial cell rests of Malassez--a role in periodontal regeneration?

This article reviews general aspects about the epithelial cell rests of Malassez (ERM). The historical and general morphological features of the ERM are briefly described. The embryological derivation of the ERM is presented as an important consideration in understanding the events associated with their origin and possible functional roles within the periodontal ligament. The ultrastructural description of the ERM is also included to complement the morphological characteristics which distinguish these cells as the unique epithelial element of the periodontal ligament. The unique ability of these cells to synthesize and secrete a number of proteins usually associated with cells of mesenchymal origin, rather than ectodermal origin, is discussed in light of their role in cementum repair and regeneration. Such considerations lead to our hypothesis that one of the functional roles of the ERM may lie not only their role in maintaining and contributing to the normal periodontal cellular elements and function but also contributing, in a significant manner, to periodontal regeneration.

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.

Distribution of CD8 and CD20 lymphocytes in chronic periapical inflammatory lesions

The objective of this study was to investigate the distribution of CD8+ and CD20+ lymphocytes in chronic periapical inflammatory lesions. A total of 90 periapical inflammatory lesions (chronic abscesses, abscessed cysts, and inflammatory cysts) were evaluated. The biotin-streptavidin immunohistochemical technique was used to identify cytotoxic/suppressor T-lymphocytes (CD8) and B-lymphocytes (CD20). Age ranged from 10 to 67 years. Patients between 26 and 45 years old (54.4%), females (52.2%), and white patients (74.4%) were more frequently affected. CD8+ cell distribution was as follows: 1) fibrous capsule: diffuse in 58.8% of chronic abscesses and absent in 64.1% of abscessed cysts and in 70.6% of inflammatory cysts; 2) infiltration zone: diffuse in 100% of abscessed cysts and in 82.4% of inflammatory cysts; 3) sub-epithelial zone: absent in 53.0% of inflammatory cysts and diffuse in 56.4% of abscessed cysts; 4) suppurative zone: diffuse in 100% of chronic abscesses and in 97.5% of abscessed cysts. CD20+ cell distribution was as follows: 1) fibrous capsule: absent in 100% of inflammatory cysts, in 94.8% of abscessed cysts, and in 88.3% of chronic abscesses; 2) infiltration zone: diffuse in 100% of abscessed cysts and in 53% of inflammatory cysts; 3) sub-epithelial zone: absent in 58.8% of inflammatory cysts and focal in 46.2% of abscessed cysts; 4) suppurative zone: diffuse in 100% of abscessed cysts and in 100% of chronic abscesses. The distribution of the lymphocytic infiltrate in the lesions was usually diffuse for both types of lymphocytes.

Heat shock protein 27 expression in the epithelium of periapical lesions

Heat shock protein (HSP) 27 is a member of the small HSP family that plays a part in the regulation of epithelial cell growth and differentiation, wound healing, apoptosis and cell protection against inflammatory cytotoxicity mediators. Thus the expression of HSP27 was investigated immunohistochemically in periapical granulomas with epithelial rests of Malassez and in radicular cysts. Anti-HSP27 mouse monoclonal antibody and peroxidase-labeled streptavidin-biotin standard technique were used to study the expression of HSP27. Proliferating epithelial cell rests, and islands of epithelium and epithelial lining of microcysts strongly reacted throughout all layers, whereas radicular cysts epithelial lining presented mainly a moderate suprabasal staining pattern. However both the proliferating epithelial cell rests and the radicular cysts shared an over-expression of HSP27 immunostaining intensity in coincidence with the presence of local infiltration of immune cells. HSP27 may play several roles in periapical lesions that include contributing to the migration of epithelial cell rests and an increased resistance both to necrotic and apoptotic cell deaths.

Immunolocalization of CD44 adhesion molecules in human periradicular lesions

OBJECTIVE

The hyaluronate receptor CD44 is a cell surface protein that is involved in several functions. To elucidate whether CD44 plays a role in periapical lesions, an immunohistochemical technique was used to study its distribution.

STUDY DESIGN

Twenty periapical lesions-16 periapical granulomas and 4 radicular cysts-constituted the sample. Formalin-fixed/paraffin-embedded tissue sections were studied by means of immunohistochemistry for the presence of the standard CD44H form and its V3 splicing variant.

RESULTS

Immunohistochemical staining for CD44H and CD44V3 was observed on epithelial, endothelial, and connective tissue cells. The cells of the fibrous lining around each granuloma were positive, showing an immune reactive pattern directly correlated with the dimension of the lesion. Epithelial rests of Malassez were strongly positive; the reaction product was also evident in the epithelial lining of the cysts. Blood vessels, mainly observed around the lesion, were immunoreactive for CD44.

CONCLUSIONS

Our findings demonstrate that CD44H and its V3 variant are expressed in at least 3 different tissue types of periapical lesions. These glycoproteins may be involved in different steps of periapical lesion pathogenesis and evolution.

Epidermal growth factor in gingival crevicular fluid and its binding capacity in inflamed and non-inflamed human gingiva

Epidermal growth factor (EGF) is a pro-inflammatory small peptide (6000 Da) with a variety of biological activities including stimulation of cell differentiation and mediation of proteolysis by binding to its specific receptor on the cell surface. The purpose of this study was to determine the levels of EGF in gingival crevicular fluid (GCF) and the EGF-binding capacity to its receptor in gingival tissue. The GCF samples were collected from six patients by inserting paper strips into shallow (< 5 mm) and deep pockets (> or = 5 mm) for 30 s. The strips were soaked in 0.2 M acetate for extraction and the EGF in the supernatants was analysed by radioimmunoassay. To determine the binding capacity of EGF to its receptor, inflamed gingival tissues (pocket depth > or = 5 mm, Gingival Index = 1, 2 or 3) were collected during periodontal flap surgery and non-inflamed gingival tissues (pocket depth < 5 mm, Gingival Index = 0) were collected during surgical "crown lengthening' for aesthetic purposes. The tissues were pooled by group, homogenized for membrane preparation and the supernatants obtained after centrifugation were used in a 125IEGF binding assay. To determine the effect of inflammation on gingival EGF receptor, inflamed and non-inflamed gingival tissues were collected from six patients and prepared similarly to the binding assay. Gingival preparations were then electrophoresed for Western blot analysis with EGF receptor antiserum. The EGF level in GCF was significantly lower (P < 0.05) in the samples collected from pockets > or = 5 mm (0.9 +/- 0.6 ng/ml) than in those from pockets < 5 mm (2.4 +/- 2.1 ng/ml). The average Gingival Index was higher (2.6 +/- 0.6) in pockets > or = 5 mm than in pockets < 5 mm (1.4 +/- 1.0). Specific binding of 125I-EGF to its receptor in inflamed gingiva was 2.7-fold higher than in non-inflamed gingiva (14.4 +/- 4.9 vs 5.4 +/- 1.8 fmol/g wet tissue). Western blot analysis showed two major immunoreactive bands (180 and 120 kDa), which represent EGF receptor and its degradation products, in inflamed gingiva. The findings show that inflammation activates EGF binding capacity in gingiva and that the up-regulation of EGF receptor in inflamed gingiva might be associated with a lowered concentration of EGF in GCF produced adjacent to inflamed gingiva. This up-regulation of EGF receptor during inflammation might be an important mechanism in the pathogenesis of periodontal disease.