ABSTRACT
INTRODUCTION: Radicular cysts (RCs) and residual radicular cysts (RRCs) are the sequelae of dental caries and that leads to proliferation of epithelial rests of Malassez in periapical tissues. OBJECTIVES: The aim was to evaluate the relationship between Langerhans cells, macrophages, matrix metalloproteinases (MMP-9, MMP-13), and tumor necrosis factor-alpha (TNF-α) in the capsule and lining epithelium of cystic lesions. MATERIALS AND METHODS: Twenty RCs and 20 RRCs were submitted to immunohistochemical analysis with anti-CD68, anti-CD1a, anti-MMP-9, anti-MMP-13, and anti-TNF-α antibodies. The Mann-Whitney test and the Spearman correlation test were used for analysis of the data (P<0.05). RESULTS: The immunoexpression of MMP-13 and CD68 was significantly higher in RCs when compared with RRCs (P=0.011 and 0.012, respectively). The presence of an intense inflammatory infiltrate was significantly correlated with the immunoexpression of CD68 in RCs (P=0.025). Expression of CD68 showed a significant positive correlation with MMP-13 (P=0.015). A moderate correlation was observed between MMP-9 and MMP-13 (P=0.010). TNF-α expression was more common in RCs (P=0.001). CD1a was more frequently expressed in atrophic epithelium (P=0.041) and was significantly correlated with TNF-α (P=0.014). CONCLUSION: Langerhans cells induce a greater release of TNF-α which, in turn, is responsible for the stimulation of M1 macrophages. Higher immunoexpression of MMP-13 and MMP-9 is observed in the early stages of RCs compared with RRCs. Therefore, the toxins of microorganisms present in highly inflamed RCs are the main factors triggering a proinflammatory immune response and greater cystic expansion in the early stages of these lesions.
Subject(s)
Dental Caries , Matrix Metalloproteinases , Periapical Granuloma , Radicular Cyst , Dental Caries/pathology , Humans , Langerhans Cells/metabolism , Macrophages/metabolism , Matrix Metalloproteinase 13/metabolism , Matrix Metalloproteinase 9/metabolism , Matrix Metalloproteinases/metabolism , Periapical Granuloma/metabolism , Periapical Granuloma/pathology , Radicular Cyst/metabolism , Radicular Cyst/pathology , Tumor Necrosis Factor Inhibitors , Tumor Necrosis Factor-alphaABSTRACT
Langerhans cells (LCs) play important roles in cell-mediated immune reactions, as well as in the pathogenesis of periapical lesions. The aim of this study is to evaluate the role of LCs in the proliferative epithelium of radicular cysts (RCs) and the release of the proinflammatory cytokine tumor necrosis factor α (TNF-α) associated with epithelial thickness. Thirty cases of RCs and 30 cases of residual RCs were randomly selected. Morphologic analysis was performed to evaluate the association between the inflammatory infiltrate, cystic epithelial thickness and lesion size, in addition to immunohistochemical assessment of CD1a, CD68, and TNF-α. The highest macrophage percentages and TNF-α scores were found in RCs (P=0.038 and 0.017, respectively). The largest number of LCs was observed in RCs (P=0.021), especially those exhibiting atrophic epithelium (P=0.05). In addition, LCs were positively correlated with the number of macrophages in both RCs and residual RCs (P=0.033 and 0.002, respectively). In contrast to LCs, the largest number of macrophages was detected in cases with an intense inflammatory infiltrate (P=0.022). In addition, the highest TNF-α scores were associated with an intense inflammatory infiltrate (P=0.024) when analyzed in the capsule of RCs (P=0.017). In conclusion, LCs participate in defense mechanisms and were present in all cases evaluated. Along with macrophages, these cells release proinflammatory cytokines such as TNF-α, which is responsible for inducing the continued proliferation of cystic epithelium.
Subject(s)
Langerhans Cells , Macrophages , Radicular Cyst , Adult , Aged , Antigens, CD/immunology , Antigens, CD1/immunology , Antigens, Differentiation, Myelomonocytic/immunology , Epithelium/immunology , Epithelium/pathology , Female , Humans , Langerhans Cells/immunology , Langerhans Cells/pathology , Macrophages/immunology , Macrophages/pathology , Male , Middle Aged , Radicular Cyst/immunology , Radicular Cyst/pathology , Tumor Necrosis Factor-alpha/immunologyABSTRACT
OBJECTIVE: To determine the course of serological tests in subjects with chronic Trypanosoma cruzi infection treated with anti-trypanosomal drugs. METHODS: A systematic review and meta-analysis was conducted using individual participant data. Survival analysis and the Cox proportional hazards regression model with random effects to adjust for covariates were applied. The protocol was registered in the PROSPERO database (http://www.crd.york.ac.uk/PROSPERO; CRD42012002162). RESULTS: A total of 27 studies (1296 subjects) conducted in eight countries were included. The risk of bias was low for all domains in 17 studies (63.0%). Nine hundred and thirteen subjects were assessed (149 seroreversion events, 83.7% censored data) for enzyme-linked immunosorbent assay (ELISA), 670 subjects (134 events, 80.0% censored) for indirect immunofluorescence assay (IIF), and 548 subjects (99 events, 82.0% censored) for indirect hemagglutination assay (IHA). A higher probability of seroreversion was observed within a shorter time span in subjects aged 1-19 years compared to adults. The chance of seroreversion also varied according to the country where the infection might have been acquired. For instance, the pooled adjusted hazard ratio between children/adolescents and adults for the IIF test was 1.54 (95% confidence interval 0.64-3.71) for certain countries of South America (Argentina, Bolivia, Chile, and Paraguay) and 9.37 (95% confidence interval 3.44-25.50) for Brazil. CONCLUSIONS: The disappearance of anti-T. cruzi antibodies was demonstrated along the course of follow-up. An interaction between age at treatment and country setting was found.
