Proteins in fluid from non-keratinizing jaw cysts. 1. Separation patterns on cellulose acetate membranes and percentage distribution of the electrophoretic fractions

Biochemical and Cytological Comparison of Keratocystic Odontogenic Tumours to Nonkeratinising Odontogenic Cysts Fluid

AIM

To evaluate the levels of albumin, prealbumin, total protein, inorganic phosphate and presence of keratinocytes in the cystic fluid for the diagnosis and appropriate treatment planning of keratocystic odontogenic tumours and other non keratinizing odontogenic cysts.

MATERIALS AND METHODS

Fifteen keratocystic odontogenic tumour and 15 controls were studied. The cystic fluid was aspirated and analysed to determine the levels of albumin, prealbumin, total protein, inorganic phosphate and the presence of keratinocytes. The data collected was statistically evaluated using Mann Whitney U-Test and Student's t-test.

RESULTS

A highly significant difference (p<0.0001) was seen when a comparison of Prealbumin, total protein, inorganic phosphate and presence of keratinocytes was made between keratocystic odontogenic tumour and non keratinizing odontogenic cysts. The presence of albumin also showed a significant difference (p<0.01).

CONCLUSION

A combined analysis of total protein, albumin, prealbumin, inorganic phosphorous and detection of epithelial squames may be used as a diagnostic adjunct in the preoperative diagnosis of keratocystic odontogenic tumour in a minimally invasive and highly accurate fashion.

A biochemical study on the nature of jaw cysts (III). Instrumental analysis of the viscous component of fluids in ciliated cysts of the maxilla

Cyst fluids are composed of electrolytes, proteins, lipids and viscous components. These substances affect the state of jaw cysts. Jaw cysts whose inner wall layer is ciliated epithelium contain high-viscosity fluids. This study comprised 30 cases of the following types of jaw cysts: nasopalatine, mucosal and ciliated cysts of the maxilla. And the author chiefly investigated ciliated cysts of the maxilla. Their fluid contents were extracted and pre-treated for analysis. It was concluded that hyaluronidase in cyst fluids causes cyst walls to decompose hyaluronic acid in the cellular interstitium of cyst walls or in the basement membrane of the cellular layer and convert it into cyst fluid, hence it is confirmed that the main component of viscous cyst fluid is hyaluronic acid.

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.

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.

Ultrastructure of odontogenic jaw cysts

The epithelial ultrastructure of six radicular cysts, four follicular cysts, and five keratocysts was studied with special attention to the epithelium-connective tissue junction. Inflammation was found to cause widened interepithelial cell spaces which often harbored inflammatory cells in the radicular and follicular cysts. The characteristic structures at the epithelium-connective tissue junction (plasma membrane, lamina lucida and basal lamina) were not affected by inflammation. Fibrous structures were seen to connect the basal lamina to the underlining collagenous connective tissue. The keratocyst specimens, however, showed juxtaepithelial collagenolysis that was not associated with the degree of inflammation. Desmosomes were rare in the inflamed keratocysts' spinous layer but the cell-to-cell interactions still appeared close. Inflammatory cells were not detected within epithelium of the keratocyst specimens.

Glycosaminoglycans in fluid aspirates from odontogenic cysts

Glycosaminoglycans and proteoglycans were analysed in keratinizing and nonkeratinizing odontogenic cyst fluids. Hyaluronic acid showed the highest incidence and abundance amongst the glycosaminoglycans detected. Appreciable amounts of chondroitin-4-sulphate were also observed, particularly in the dental cysts, with lesser amounts of the other glycosaminoglycans. Heparan sulphate showed a higher incidence and abundance in the keratocyst than the other cysts, whilst chondroitin-6-sulphate could not be detected in any of the cysts. A considerable proportion of the glycosaminoglycans of the fluids appeared to be complexed with protein and was released only after proteolytic digestion. The origin of these macromolecules is uncertain although it is likely that they are derived from both the connective tissue and the epithelium of the cyst wall.

The demonstration of alpha 1 antitrypsin in periapical lesions

Discontinuous vertical gel electrophoresis was applied to samples of root canal aspirate, periapical blood, and control blood from twelve periapical lesions. The periapical sample from ten of the twelve lesions showed an additional band in the alpha 1 globulin area which was not present in the control. By means of Grabbar-Williams immunoelectrophoresis to specific antisera, the band was subsequently identified as alpha 1 antitrypsin. The results suggest that the regulation of proteolytic activity afforded by alpha 1 antitrypsin plays an important role in the pathogenesis of periapical lesions.

1-naphthyl acetate esterases in fluids and tissues of jaw cysts

The activity and electrophoretic mobility of 1-naphthyl acetate esterases in cystic fluids and cystic tissues of ameloblastomas, follicular and apical cysts were examined. The cystic fluids showed lower activities than sera but had very similar patterns on the electrophoretogram. The activity levels of the three kinds of cystic fluids were not statistically significantly different. The fluid esterases may have originated from serum but they were not produced by the cystic lining tissue. Ameloblastoma tissues showed the highest activity per wet weight and per mg protein of the three kinds of cyst lesions (P less than 0.05). On the electrophoretogram, the esterase-I activity constituted 41% of the total activity in ameloblastomas, whereas in follicular cysts and apical cysts the esterase-I activity constituted 32% and 24% of the total activity, respectively.

Soluble proteins in fluid from non-keratinizing jaw cysts in man

Fluids from non-keratinizing cysts of the jaws contain the main proteins found in plasma. The low relative concentration of macromolecular non-immunoglobulin proteins shows that there is no free passage of plasma proteins into the cyst fluid. Sufficient evidence was found to conclude that the immunoglobulins in cyst fluid are partly produced locally and partly derived from plasma. Cyst fluid immunoglobulins have antibody activity to rabbit erythrocytes. Accumulation of cyst fluid is primarily due to inadequate lymphatic drainage of the cyst cavity. Differential diagnosis between various types of non-keratinizing cysts cannot be based on the plasma protein patterns of their fluids.

Identification and quantitation of carbohydrates in fluid from non-keratinizing jaw cysts

Glucose, mannose, galactose, glucosamine, and fucose were detected by paper or thin-layer chromatography, and N-acetylneuraminic acid (sialic acid) was identified by absorption spectroscopy in acid hydrolysates of pooled cyst fluid. Quantitation of these monosaccharides in 37 frozen-stored cyst fluids and autologous sera showed that the average content of hexoses, hexosamine, and sialic acid in cyst fluid approximated that in serum, whereas cyst fluid contained significantly more fucose than did serum. Fifteen of the cyst fluids and samples of autologous serum were also analyzed for free glucose. A mean cyst fluid to serum concentration ratio of 0.48 was found. The results show that the sugar components bound to proteins are the same in cyst fluid and serum. High levels of fucose in cyst fluid indicate the presence of fucomucins.

Lipoproteins in fluid from non-keratinizing jaw cysts

Forty-seven cyst fluids and autologous sera were examined for lipoproteins (LP) by cellulose acetate membrane (CAM) electrophoresis, immunoelectrophoresis and quantitative analyses for beta-lipoprotein and cholesterol. By CAM electrophoresis all cyst fluids showed alpha1-LP and betal-LP bands but no pre-beta-LP band. Four cyst fluids exhibited and additional, well-defined lipid-staining band located within the gamma-globulin zone (post-beta-band). The relative amount of alpha1-LP was higher in cyst fluid than in serum. Single radial immunodiffusion showed that the content of beta-LP was low. On an average, cyst fluid contained more cholesterol than did serum. Some cyst fluids were particularly rich in cholesterol. It is hypothesized that the cholesterol is derived partly from beta-LP originating from plasma.

Evidence of the presence of rheumatoid factor and antibodies reacting with human and rabbit IgA in fluid from non-keratinizing jaw cysts

Fluid from an apical periodontal and a follicular jaw cyst formed, in double diffusion in agarose gel, a continuous precipitin line against IgA isolated from human and rabbit serum, IgA myeloma protein, and secretory IgA. Results of immunoelectrophoresis and absorption experiments indicated that the IgA precipitating factor was an immunoglobulin belonging to the IgM class. Furthermore, the two cyst fluids contained immune complexes, possibly IgA-anti-IgA, which precipitated in agar gel. The same two cyst fluids showed a positive reaction in the Waaler-Rose test with tires of 40 and 80, respectively. A series of the other cyst fluids examined were negative in the Waaler-Rose test. None of the cyst fluids conatined antinuclear antibodies.

Some observations on the fluids of odontogenic cysts

The fluids of 44 dental cysts, 19 dentigerous cysts, 36 odontogenic keratocysts, and 12 ameloblastomas have been investigated. The incidence of epithelial cells, inflammatory cells, cholesterol crystals and bacteria was recorded in smears. There was a high incidence of epithelial cells in odontogenic keratocysts and not in other lesions. Cholesterol crystals had a similar incidence in all lesions. The proportion of the soluble proteins and total protein content was determined from cellulose acetate electrophoresis. Dental cysts contained an average of 51.19% albumin, 17.52% beta globulin, 22.04 % gamma globulin, and 6.30 g/100 ml protein. Dentigerous cysts contained an average of 61.35% albumin, 13.98% beta globulin, 12.70% gamma globulin and 5.40 g/100 ml protein. Odontogenic keratocysts contained an average of 78.03% albumin, 7.51% beta globulin, 7.91% gamma globulin, and 2.09 g/100 ml protein. Ameloblastomas contained an average of 67.38% albumin, 12.83% beta globulin, 12.60% gamma globulin and 4.86 g/100 ml protein. The immunoglobulin content was determined by single radial immunodiffusion. Dental cysts contained an average of 488.9 mg/100 ml IgA, 2535.4 mg/100 ml IgG, and 135.6 mg/100 ml IgM. Dentigerous cysts contained an average of 308.4 mg/100 ml IgA, 1618.2 mg/100 ml IgG, and 155.6 mg/100 ml IgM. Odontogenic keratocysts contained an average of 135.6 mg/100 ml IgA, 491.9 mg/100 ml IgG, and 54.1 mg/100 ml IgM. The significance of these findings in the pathogenesis and diagnosis of these lesions is discussed.

Immunoglobulins in fluid from non-keratinizing jaw cysts

Thirty-six fluids from non-keratinizing jaw cysts have been examined together with autologous sera by immunoelectrophoresis and double diffusion in agar or agrose gels. Except for one cyst fluid which contained electrophoretically homogeneous ("monoclonal") IgG of the kappa type together with free kappa chains, IgG of cyst fluid was electrophoretically heterogeneous. For the most, IgA of cyst fluid migrated more slowly than IgA of serum, whereas the IgM migrated similarly. The three immunoglobulins showed reactions of antigenic identity with the corresponding Ig classes of serum when examined with rabbit antisera against human IgG, IgA, and IgM. Fluid from the median palatine cyst contained secretory component, which showed a reaction of identity with free secretory component isolated from human saliva, and probably also IgA of the secretory type. Two cyst fluids also precipitated a component in rabbit serum.

The pathogenesis of odontogenic cysts: a review

The pathogenesis of the three common forms of odontogenic cyst is discussed. It is concluded that the dental cyst arises from proliferation of the epithelial rests of Malassez in a focus of inflammation stimulated by pulpal necrosis of the associated tooth. It enlarges by unicentric expansion from the hydrostatis pressure of its contents. The dentigerous cyst arises from pooling of inflammatory exudate, which is derived from the obstructed follicular veins of an unerupted tooth and accumulates between the reduced enamel epithelium and the crown of the tooth. It enlarges by unicentric expansion from the hydrostatic pressure of its contents. The odontogenic keratocyst arises by proliferation of the residues of the dental lamina, possibly as a hamartomatous abnormality. It enlarges by both multicentric expansion due to the proliferation of localized groups of epithelial cells in the lining and by unicentric expansion from the hydrostatic pressure of its contents.

Glycoproteins in fluid from non-keratinizing jaw cysts

Fluid from 47 non-keratinizing jaw cysts and autologous serum were separated by electrophoresis on cellulose acetate membranes and stained for glycoproteins. All cyst fluids contained glycoproteins, but the separation patterns differed from those of serum. The major carbohydrate-bearing fractions of cyst fluid migrated with alpha2- and gamma-globulins, while in serum alpha2 and beta-glycoproteins contained most bound carbohydrates. The appearance of the gamma-globulin patterns indicated local synthesis and accumulation of cyst fluid gamma-globulins. The other glycoproteins most likely had escaped from plasma. Electrophoretograms of cyst fluid stained for glycosaminoglycans revealed that cystic glycoproteins often were complexed with glycosaminoglycans, causing more or less distorted separation patterns.