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1.
Parasit Vectors ; 17(1): 232, 2024 May 20.
Article in English | MEDLINE | ID: mdl-38769548

ABSTRACT

BACKGROUND: Schistosoma japonicum eggs lodge in the liver and induce a fibrotic granulomatous immune response in the liver of host. Galectin 3 (Gal-3) is a protein implicated in fibrosis in multiple organs. However, the pathology and molecular mechanisms promoting hepatic granuloma formation remain poorly understood. METHODS: To investigate the effect of blocking galectin-receptor interactions by α-lactose on liver immunopathology in mice with S. japonicum infection, C57BL/6 mice were infected with S. japonicum and alpha (α)-lactose was intraperitoneally injected to block the interactions of galectins and their receptors. RESULTS: Compared with S. japonicum-infected mice, there were significantly decreased Gal-3 mRNA and protein expression levels, decreased intensity of Gal-3 fluorescence in the liver, decreased serum ALT and AST levels, decreased egg numbers of S. japonicum in the liver section, attenuated hepatic and spleen pathology, and alleviated liver fibrosis accompanied with decreased protein expression levels of fibrosis markers [α-smooth muscle actin (α-SMA), collagen I, and collagen IV] in the liver of S. japonicum-infected mice blocked galectin-receptor interactions with hematoxylin-eosin staining, Masson's trichrome staining, immunohistochemistry, or Western blot analysis. Compared with S. japonicum-infected mice, blocking galectin-receptor interactions led to increased eosinophil infiltration and higher eosinophil cationic protein (ECP) expression in the liver, accompanied by increased mRNA levels of eosinophil granule proteins [ECP and eosinophil peroxidase (EPO)], IL-5, CCL11, and CCR3 in the liver and decreased mRNA levels of Gal-3 and M2 macrophage cytokines (TGF-ß, IL-10, and IL-4) in the liver and spleen by using quantitative real-time reverse transcription-polymerase chain reaction. In addition, there were increased Beclin1 protein expression and protein expression ratio of LC3B-II/LC3B-I and decreased p62 protein expression and protein expression ratios of phospho-mTOR/mTOR and phospho-AKT/AKT by Western blot; increased double-labeled F4/80+/LC3B+ cells by immunofluorescence staining; increased M1 macrophage polarization in the liver of S. japonicum-infected mice blocked galectin-receptor interactions by flow cytometric analysis and immunofluorescence staining. CONCLUSIONS: Our data found that blockage of galectin-receptor interactions downregulated Gal-3, which in turn led to reduced liver functional damage, elevated liver eosinophil recruitment, promoted macrophage autophagy through the Akt/mTOR signaling pathway, and alleviated liver pathology and fibrosis. Therefore, Gal-3 plays a pivotal role during S. japonicum infection and could be a target of pharmacologic potential for liver fibrosis induced by S. japonicum infection.


Subject(s)
Galectin 3 , Liver Cirrhosis , Mice, Inbred C57BL , Schistosoma japonicum , Schistosomiasis japonica , Animals , Schistosomiasis japonica/parasitology , Schistosomiasis japonica/complications , Liver Cirrhosis/parasitology , Liver Cirrhosis/metabolism , Liver Cirrhosis/pathology , Mice , Galectin 3/metabolism , Galectin 3/genetics , Liver/parasitology , Liver/pathology , Liver/metabolism , Female , Lactose/pharmacology , Lactose/analogs & derivatives , Galectins/metabolism , Galectins/genetics
2.
Front Immunol ; 12: 758052, 2021.
Article in English | MEDLINE | ID: mdl-34899708

ABSTRACT

Hepatopathy is frequently observed in patients with severe malaria but its pathogenesis remains unclear. Galectins are evolutionarily conserved glycan-binding proteins with pleiotropic roles in innate and adaptive immune responses, and exhibit pivotal roles during Plasmodium spp. infection. Here, we analyzed the impact of blockage of galectin-receptor interactions by treatment with alpha (α)-lactose on liver immunopathology during the erythrocytic stage of malaria in mice infected with Plasmodium berghei ANKA (PbANKA). Our results found that compared with PbANKA-infected mice (malarial mice), blockage of galectin-receptor interactions led to decreased host survival rate and increased peripheral blood parasitemia; exacerbated liver pathology, increased numbers of CD68+ macrophages and apoptotic cells, and increased parasite burden in the livers on days 5 and 7 post infection (p.i.) as well as increased mRNA expression levels of galectin-9 (Gal-9) and its receptor, the T cell immunoglobulin domain and mucin domain protein 3 (Tim-3), interferon (IFN)α, IFNγ, and the triggering receptor expressed on myeloid cells (TREM)-1 in the livers or spleens of PbANKA-infected mice on day 7 p.i. Observed by transmission electron microscopy, the peritoneal macrophages isolated from malarial mice with α-lactose treatment had more pseudopodia than those from malarial mice. Measured by using quantitative real-time reverse transcription-polymerase chain reaction assay, the mRNA expression levels of Gal-9, IFNα, IFNß, IFNγ, and TREM-1 were increased in the peritoneal macrophages isolated from malarial mice with α-lactose treatment in comparison of those from malarial mice. Furthermore, significant positive correlations existed between the mRNA levels of Gal-9 and Tim-3/IFNγ/TREM-1 in both the livers and the peritoneal macrophages, and between Gal-9 and Tim-3/TREM-1 in the spleens of malarial mice; significant positive correlations existed between the mRNA levels of Gal-9 and IFNγ in the livers and between Gal-9 and IFNα in the peritoneal macrophages from malarial mice treated with α-lactose. Our data suggest a potential role of galectin-receptor interactions in limiting liver inflammatory response and parasite proliferation by down-regulating the expressions of IFNα, IFNγ, and TREM-1 during PbANKA infection.


Subject(s)
Erythrocytes/parasitology , Galectins/physiology , Liver/pathology , Malaria/pathology , Parasitemia/pathology , Animals , Antigens, CD/metabolism , Antigens, Differentiation, Myelomonocytic/metabolism , Female , Galectins/antagonists & inhibitors , Hepatitis A Virus Cellular Receptor 2/antagonists & inhibitors , Hepatitis A Virus Cellular Receptor 2/genetics , Hepatitis A Virus Cellular Receptor 2/metabolism , Interferon Type I/genetics , Interferon Type I/metabolism , Lactose/pharmacology , Lactose/toxicity , Liver/parasitology , Lung/metabolism , Macrophages, Peritoneal/immunology , Macrophages, Peritoneal/metabolism , Macrophages, Peritoneal/ultrastructure , Malaria/blood , Mice , Plasmodium berghei/growth & development , Pseudopodia/ultrastructure , RNA, Messenger/biosynthesis , RNA, Messenger/genetics , Receptors, Immunologic/biosynthesis , Receptors, Immunologic/genetics , Triggering Receptor Expressed on Myeloid Cells-1/biosynthesis , Triggering Receptor Expressed on Myeloid Cells-1/genetics
3.
Front Immunol ; 12: 639260, 2021.
Article in English | MEDLINE | ID: mdl-34093526

ABSTRACT

The parasitic nematode Trichinella spiralis causes trichinellosis, a serious food-borne parasitic zoonosis worldwide. Infection with T. spiralis may also cause myocarditis. In the present study, we used mouse models to assess the impact of blockage of galectin-receptor interactions by α-lactose on cardiac immunopathology during acute T. spiralis experimental infection. Our data demonstrated that, after T. spiralis infection, blockage of galectin-receptor interactions resulted in cardiac dysfunction detected by transthoracic conventional echocardiography, and increased serum Gal-3 level, a biomarker of myocardial damage. In addition, there were increased eosinophil number in peripheral blood, and increased eosinophil infiltration in the heart and spleen tissues accompanied with increased mRNA levels of eosinophil granule proteins (including eosinophil cationic protein (ECP) and eosinophil peroxidase (EPO)) and IL-5 in these organs; increased cardiac fibrosis accompanied with increased Gal-3 and collagen 1 expressions in the hearts of mice with blockage of galectin-receptor interactions after T. spiralis infection. Correlation analysis showed that significant positive correlations existed between the mRNA levels of Gal-3 and ECP/EPO/eosinophil major basic protein/IL-5/CCL11/CCR3/α-SMA/collagen 1 in the hearts of both T. spiralis-infected mice and T. spiralis-infected mice with blockage of galectin-receptor interactions. Our data suggest that galectin-receptor interactions play a pivotal role during acute T. spiralis infection, and lack of galectin-receptor interactions upregulates Gal-3 which, in turn, leads to elevated heart eosinophil recruitment, exacerbated heart pathology and fibrosis, and heart functional damage.


Subject(s)
Galectins/metabolism , Heart Diseases/metabolism , Heart Diseases/pathology , Heart/parasitology , Trichinella spiralis/parasitology , Trichinellosis/metabolism , Trichinellosis/pathology , Animals , Cytokines/metabolism , Disease Models, Animal , Eosinophilia/metabolism , Eosinophilia/parasitology , Eosinophilia/pathology , Eosinophils/metabolism , Eosinophils/parasitology , Eosinophils/pathology , Female , Fibrosis/metabolism , Fibrosis/parasitology , Fibrosis/pathology , Heart Diseases/parasitology , Mice , RNA, Messenger/metabolism , Spleen/metabolism , Spleen/parasitology , Spleen/pathology , Trichinellosis/parasitology , Up-Regulation/physiology
4.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-862498

ABSTRACT

@#Cyclophilin A (CypA) is the first foldable enzyme in human cells that has peptidyl proliferase-trans isomerase activity and has a strong proinflammatory effect. CD147 can act as the signal receptor of CypA. The interaction of the two through cell-surface heparin binding activates extracellular regulated protein kinases (ERK1/2) and nuclear factor kappa-B (NF-κB) signaling pathways in macrophages and increases the expression of MMPs and other inflammatory factors. The CypA/CD147 interaction regulates inflammation, promotes the inflammatory response and bone resorption and is involved in the pathological processes of a variety of systemic diseases. CypA and CD147 may take part in the chemotaxis of inflammatory cells, increase white blood cell infiltration in tissues, and increase CypA and CD147 expression in periodontitis gum tissue and gingival groove liquid with inflammation, prompting their interaction to promote the progression of periodontitis. However, the specific function of the signaling pathways in the periodontitis mechanism still requires further elucidation.

5.
Parasit Vectors ; 13(1): 440, 2020 Sep 03.
Article in English | MEDLINE | ID: mdl-32883347

ABSTRACT

BACKGROUND: Although Plasmodium parasites and intestinal helminths share common endemic areas, the mechanisms of these co-infections on the host immune response remain not fully understood. Liver involvement in severe Plasmodium falciparum infections is a significant cause of morbidity and mortality. However, the effect of pre-existing Trichinella spiralis infection on the immune response and liver immune-pathogenesis in P. berghei ANKA (PbANKA)-infected mice needs to be elucidated. METHODS: Outbred Kunming mice were infected with T. spiralis and 9 days later were challenged with P. berghei ANKA (PbANKA), and the investigation occurred at 13 days after co-infection. RESULTS: Compared with PbANKA-mono-infected mice, T. spiralis + PbANKA-co-infected mice had similar survival rate but lower PbANKA parasitaemia; however, there were more severe hepatosplenomegaly, increased liver and spleen indexes, and increased liver pathology observed by hematoxylin and eosin staining; higher expression levels of galectin (Gal)-1, Gal-3, CD68+ macrophages, and elastase-positive neutrophils measured by immunohistochemical staining; upregulated mRNA expression levels of Gal-1, Gal-3, cytokines (interferon-gamma (IFNγ) and interleukin (IL)-6), and M1 macrophage polarization marker (inducible nitric oxide synthase (iNOS)) in the liver, and increased expression levels of Gal-1, IFNγ, IL-6, eosinophil cationic protein, eosinophil protein X, and M1 (IL-1ß and iNOS) and M2 (Ym1) macrophage polarization markers in the spleen of co-infected mice detected by using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). In vitro study showed that compared with PbANKA-mono-infected mice, there were significantly increased expression levels of Gal-1, Gal-3, IL-6, IL-1ß, and iNOS in the peritoneal macrophage isolated from co-infected mice detected by using qRT-PCR. Correlation analysis revealed significant positive correlations between Gal-3 and IL-1ß in the peritoneal macrophages isolated from PbANKA-mono-infected mice, between Gal-3 and IFNγ in the spleen of co-infected mice, and between Gal-1 and Ym1 in the peritoneal macrophages isolated from co-infected mice. CONCLUSIONS: Our data indicate that pre-existing infection of T. spiralis may suppress P. berghei parasitaemia and aggravate malaria-induced liver pathology through stimulating Gal-1 and Gal-3 expression, activating macrophages, neutrophils, and eosinophils, and promoting mediator release and cytokine production.


Subject(s)
Coinfection , Liver/pathology , Plasmodium berghei , Trichinella spiralis , Animals , Blood Cell Count , Coinfection/immunology , Coinfection/pathology , Cytokines/metabolism , Disease Models, Animal , Eosinophils/immunology , Eosinophils/metabolism , Galectins/metabolism , Liver/parasitology , Macrophages/immunology , Macrophages/metabolism , Malaria/immunology , Malaria/pathology , Mice , Neutrophils/immunology , Neutrophils/metabolism , Parasitemia/pathology , Plasmodium berghei/immunology , Plasmodium berghei/pathogenicity , Spleen/parasitology , Spleen/pathology , Trichinella spiralis/immunology , Trichinella spiralis/pathogenicity , Trichinellosis/immunology , Trichinellosis/pathology
6.
Front Immunol ; 11: 146, 2020.
Article in English | MEDLINE | ID: mdl-32231658

ABSTRACT

Schistosomiasis is a severe public health problem, which can cause tissue fibrosis and can even be fatal. Previous studies have proven that galectins and different kinds of cells involve in the regulation of tissue fibrosis process. In this study, outbred Kunming mice were infected with Schistosoma japonicum (S. japonicum). Our results showed that compared with uninfected mice, there were severe egg granulomatous inflammation and tissue fibrosis in the livers, spleens, and large intestines of S. japonicum-infected mice at 8 weeks post-infection (p.i.), and the number of eosinophils by hematoxylin and eosin staining and CD68 macrophage-positive area by immunohistochemical staining were significantly increased. Detected by using quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR), at 8 weeks after S. japonicum infection, the mRNA expression levels of galectin (Gal)-1, Gal-3, CD69, eosinophil protein X (EPX), and chitinase 3-like protein 3 (Ym1) were significantly increased in liver, spleen, and large intestine; eotaxin-1 (CCL11) and eosinophil cationic protein were significantly increased in both liver and spleen; eotaxin-2 (CCL24) and Arginase1 (Arg1) were significantly increased in both spleen and large intestine; and CD200R was significantly increased in both liver and large intestine. However, interleukin (IL)-1ß and inducible nitric oxide synthase (iNOS) were only significantly increased in liver. The M2/M1 ratio of CD200R/CD86 genes was significantly increased in liver, and ratios of Ym1/IL-1ß and Ym1/iNOS were significantly increased in liver, spleen, and large intestine of S. japonicum-infected mice. Ex vivo study further confirmed that the levels of Gal-1, Gal-3, CD200R, Arg1, and Ym1 were significantly increased, and the ratios of CD200R/CD86 and Ym1/IL-1ß were significantly increased in peritoneal macrophages isolated from S. japonicum-infected mice at 8 weeks p.i. In addition, correlation analysis showed that significant positive correlations existed between mRNA levels of Gal-1/Gal-3 and EPX in liver, between Gal-3 and Ym1 in both liver and large intestine, and between Gal-3 and CD200R in peritoneal macrophages of S. japonicum-infected mice. Our data suggested that Gal-1, Gal-3, eosinophils, and macrophages are likely involved in the development of egg granulomatous response and fibrosis induced by S. japonicum infection.


Subject(s)
Eosinophils/immunology , Galectin 1/metabolism , Galectin 3/metabolism , Macrophages, Peritoneal/immunology , Schistosoma japonicum/metabolism , Schistosomiasis japonica/immunology , Animals , Disease Models, Animal , Eosinophil-Derived Neurotoxin/genetics , Eosinophil-Derived Neurotoxin/metabolism , Female , Fibrosis , Galectin 1/genetics , Galectin 3/genetics , Intestine, Large/metabolism , Intestine, Large/pathology , Lectins/genetics , Lectins/metabolism , Liver/metabolism , Liver/pathology , Membrane Glycoproteins/genetics , Membrane Glycoproteins/metabolism , Mice , RNA, Messenger/genetics , Schistosomiasis japonica/parasitology , Spleen/metabolism , Spleen/pathology , beta-N-Acetylhexosaminidases/genetics , beta-N-Acetylhexosaminidases/metabolism
7.
Front Microbiol ; 10: 2264, 2019.
Article in English | MEDLINE | ID: mdl-31649630

ABSTRACT

Ocular toxoplasmosis (OT) is one of the most common causes of posterior uveitis. The signaling of triggering receptor expressed on myeloid cells (TREM)-1 amplifies inflammation, whereas TREM-2 signaling is anti-inflammatory. IL-1ß is a major driver of inflammation during infection. Toll-like receptors (TLRs) play important roles in protective immune response during Toxoplasma gondii infection, and interleukin (IL)-33 receptor (T1/ST2) signaling prevents toxoplasmic encephalitis in mice. However, the pathogenic mechanisms of OT are not yet well elucidated. To investigate the role of TREM-1, TREM-2, IL-1ß, IL-33/ST2, and TLRs in OT of susceptible C57BL/6 (B6) and resistant BALB/c mice, both strains of mice were intravitreally infected with 500 tachyzoites of the RH strain of T. gondii. Histopathological analysis showed that T. gondii-infected B6 mice had more severe ocular damage observed by light microscopy, higher number of neutrophil elastase-positive cells in the eyes detected by immunohistochemical staining, more T. gondii tachyzoites in the eyes observed by transmission electron microscopy, and higher mRNA expression levels of tachyzoite-specific surface antigen 1 detected by quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) in comparison of T. gondii-infected BALB/c mice. Detected by using qRT-PCR, the mRNA expression levels of TREM-1, IL-1ß, IL-33, ST2, TLR11, TLR12, and TLR13 were significantly higher in the eyes of T. gondii-infected B6 mice than those of T. gondii-infected BALB/c mice, whereas the mRNA expression levels of TLR3 and TLR9 were significantly higher in the eyes of T. gondii-infected BALB/c mice than those of T. gondii-infected B6 mice. Correlation analysis showed that significant positive correlations existed between TREM-1 and IL-1ß/IL-33/ST2/TLR9/TLR11 in the eyes of B6 mice and existed between TREM-1 and IL-33/ST2/TLR3/TLR9/TLR13 in the eyes of BALB/c mice after ocular T. gondii infection. Our data revealed that, compared with T. gondii-resistant BALB/c mice, ocular T. gondii infection can stimulate higher production of TREM-1, IL-33, ST2, TLR11, TLR12, and TLR13 in the eyes of T. gondii-susceptible B6 mice, however, whether those lead to more severe ocular pathology in the susceptible B6 mice remain to be further studied.

8.
Article in English | MEDLINE | ID: mdl-31552201

ABSTRACT

Malaria, a mosquito-borne infectious disease, is a severe health problem worldwide. As reported, some anti-malarial drugs with anti-parasitic properties also block mast cells (MCs) activities. It is hypothesized that MCs activity may be correlated with the pathogenesis of malaria. Thus, the role of MCs on malarial pathogenesis and the involved physiological action and pathways need to be further investigated. This study aimed to investigate the effect of MCs activation on malaria disease severity using KunMing mice with Plasmodium berghei ANKA (PbANKA) infection treated with MCs degranulator (compound 48/80, C48/80) or MCs stabilizer (disodium cromoglycate, DSCG). PbANKA infection caused a dramatic increase in MCs density and level of MCs degranulation in cervical lymph node (CLN) and skin. Compared with infected control, C48/80 treatment had shortened survival time, increased parasitemia, exacerbated liver inflammation and CLN hyperplasia, accompanied with increase in vascular leakage and leukocyte number. The infected mice with C48/80 treatment also elevated the release of CCL2, CXCL1, and MMP-9 from MCs in CLN and skin, and TNF-α, IFN-γ, CCR2, and CXCR2 mRNA expression in CLN and liver. In contrast, the infected mice treated with DSCG showed longer survival time, lower parasitemia, improved liver inflammation and CLN hyperplasia, followed by a decline of vascular leakage and leukocyte number. Decreased MCs-derived CCL2, CXCL1, and MMP-9 from CLN and skin, mRNA expression in CLN and liver (TNF-α, IFN-γ, CCR2, and CXCR2) were also observed in infected mice with DSCG treatment. Our data indicated that MCs activation may facilitate the pathogenesis of PbANKA infection.


Subject(s)
Malaria/physiopathology , Mast Cells/immunology , Plasmodium berghei/immunology , Animals , Cromolyn Sodium/administration & dosage , Cytokines/analysis , Disease Models, Animal , Immunologic Factors/administration & dosage , Lymph Nodes/pathology , Malaria/parasitology , Malaria/pathology , Mast Cells/drug effects , Mice , Parasitemia , Skin/pathology , Survival Analysis , p-Methoxy-N-methylphenethylamine/administration & dosage
9.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-750562

ABSTRACT

Objective @# To evaluate the expression of the receptor for advanced glycation end products (RAGE) in gingival tissue endothelial cells from type 2 diabetic rats with chronic periodontitis and to explore the role of RAGE in the pathogenesis of diabetes in cases with chronic periodontitis.@*Methods@#Sixty 7-week-old female Wistar diabetic obese rats were randomly divided into two groups. Periodontitis was induced in 30 rats by silk ligation, and the other 30 rats were used as the control group in which the periodontal tissues were not treated. One week after periodontal ligation and inoculation, the periodontitis and control group rats were randomly divided into two subgroups; the first subgroup was fed a high-fat diet, and the second group was fed a low-fat diet. Thus, 15 rats per group were included in the high-fat diet periodontitis (HF/P), low-fat diet periodontitis (LF/P), high-fat diet periodontal health (HF/C), and low-fat diet periodontal health (LF/C) groups. Glucose tolerance tests were performed weekly to measure the fasting insulin and blood glucose levels and the insulin resistance index to verify successful construction of the rat diabetes model. After successful modeling of chronic periodontitis, the rats were sacrificed at the 13th week after measurement of the serum necrosis factor-α (TNF-α), interleukin-6 (IL-6) and leptin levels. The tooth periodontal tissues were prepared and sectioned to observe histological changes. Immunofluorescence double staining was used to detect the density of RAGE-positive endothelial cells in the gingival tissues of the four groups.@* Results @#The serum fasting blood glucose and insulin levels and insulin resistance index were significantly higher in the HF/P and HF/C groups than in the LF/P and LF/C groups (P < 0.01). The serum TNF-α and IL-6 levels were significantly higher in the HF/P and LF/P groups than in the HF/C and LF/C groups (P < 0.01). The serum leptin levels were significantly higher in the HF/P group than in the other three groups. The density of RAGE-positive endothelial cells was significantly higher in the HF/P and HF/C groups than in the LF/P (P=0.001) and LF/C groups (P=0.040). The density of RAGE-positive endothelial cells in the HF/P group was higher than that in the HF/C group (P=0.027).@*Conclusion@#Endothelial cells in type 2 diabetic rats with periodontitis have increased gingival tissue RAGE and serum leptin levels.

10.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-750737

ABSTRACT

Objective@#To observe the expression of interleukin-33 (IL-33) in macrophages of chronic periapical periodontitis and apical cyst tissue, and to provide a basis for the study of the pathogenesis of IL-33 in periapical diseases.@*Methods @#The apical tissues of 20 normal control group, 15 chronic periapical periodontitis group and 15 apical cyst group were collected for HE staining and optical microscopy respectively. CD14 was used as the marker of macrophages and double immunofluorescence staining was used to observe the changes of periapical tissues under fluorescence microscopy. The expression of IL-33 in CD14-positive macrophages was observed.@*Results@#The macrophage density (cell/mm 2) of IL-33 and CD14 positive expression in normal control group, chronic periapical periodontitis group and root cyst group were(23.81 ± 5.16,62.97 ± 8.54,119.83 ± 14.61) respectively, and there were significant differences among the three groups(F=87.17,P < 0.01). The density of IL-33 and CD14 positive macrophages in root cyst group was significantly higher than that in chronic periapical periodontitis group and control group(P < 0.01).@*Conclusion@#IL-33 and CD14 positive macrophages increased in normal apical tissue, chronic periapical periodontitis tissue and apical cyst tissue in turn.

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