Epithelial-mesenchymal transition in gingival tissues from chronic periodontitis patients: A case-control study.

BACKGROUND: It has been proposed that epithelial-mesenchymal transition (EMT) is responsible for the pathogenesis of several diseases. However, the relationship between the EMT process and the severity of periodontitis has not been previously investigated. OBJECTIVES: This study aimed to localize and quantitatively assess the expression of transforming growth factor-beta 1 (TGF-ß1), vimentin and E-cadherin in correlation with the EMT process in human gingiva of periodontally diseased patients in comparison with halthy individuals. MATERIAL AND METHODS: Gingival tissue samples from 36 participants were divided into 2 groups: the healthy (control) group (n = 9); and the periodontitis group (n = 27). The periodontitis group was further subclassified into mild, moderate and severe periodontitis subgroups (9 patients in each subgroup). The samples were subjected to histological staining, the histomorphometric analysis and the quantitative real-time polymerase chain reaction (RT­PCR) analysis for TGF-ß, vimentin and E-catherin. Statistical and correlation analyses were performed. RESULTS: The hematoxylin and eosin (H&E) stain sections from both the moderate and severe periodontitis subgroups showed epithelial hyperplasia, perinuclear haloing and a marked increase in the inflammatory cell count as compared to the control group. The highest mean TGF-ß1 and vimentin expression values were recorded in the severe periodontitis subgroup, whereas the lowest mean values were recorded in the control gingiva. On the contrary, the expression of E-catherin had the highest mean value in the control gingiva, whereas the lowest mean value was recorded in the severe periodontitis subgroup. All results were found to be statistically significant. The correlation analysis revealed a statistically significant positive correlation between the severity of periodontitis and the expression of TGF-ß and vimentin, while a statistically significant inverse correlation was found between the expression of E-catherin and the severity of periodontitis. CONCLUSIONS: There is a direct correlation between the severity of periodontitis and the expression of the EMT process markers (TGF-ß and vimentin). This correlation indicates that EMT plays an important role in the pathogenesis and prognosis of periodontal disease. The data presented in this study could open the door for using anti-EMT agents in treating periodontal disease.