ALDH1 expression and potential clinical implications in chronic inflammatory periapical lesions

Farias, Zilda Betânia Barbosa Medeiros de; Silva, Leorik Pereira da; de Arruda, José Alcides Almeida; Cavalcante, Jade de Souza; Almeida, Híttalo Carlos Rodrigues de; Oliveira, Maria Cristina Valença de; Souza, Lélia Batista de; Sobral, Ana Paula Veras

doi:10.1590/1807-3107bor-2022.vol36.0019

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Original Research, Oral Pathology • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0019 copy

ALDH1 expression and potential clinical implications in chronic inflammatory periapical lesions

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Aldehyde dehydrogenase 1 (ALDH-1) is a marker of stem cells in a variety of diseases, but its role in individuals with chronic inflammatory periapical lesions remains unknown. The aim of this study was to investigate the presence of cells with a stem cell profile based on the immunoexpression of ALDH-1 in periapical granulomas (PGs) and radicular cysts (RCs). A total of 51 cases of periapical lesions (25 PGs and 26 RCs) were subjected to immunohistochemical study. The anti-ALDH-1 antibody was applied using the immunoperoxidase technique. An immunoexpression score (intensity vs. percentage of cells) was used, with the cases being classified as low expression (score: 0 to 4) and high expression (score: 6 to 9). The Chi-square test was used with a 5% level of significance. Immunoexpression of ALDH-1 was detected in all cases of PGs and RCs. In PG cases, the expression was diffuse in connective tissue cells, with most cases exhibiting high expression (n = 18; 69.2%), while in RC cases the expression revealed focal distribution in cells of the capsule and epithelial cells of the cystic lining, with most cases classified as low expression (n = 18; 72%). Significant differences in the expression scores of ALDH-1 were observed in PGs (p = 0.003). The variable expression of ALDH-1 suggests the presence of cells with stem cell profiles in PGs and RCs. These findings suggest that periapical tissues infiltrated by chronic inflammation can recruit important cells for the repair or evolution of periapical lesions.

Keywords:
Aldehyde Dehydrogenase 1 Family; Immunohistochemistry; Periapical Diseases; Periapical Granuloma; Radicular Cyst

Variables		Periapical granuloma (n = 25)	Radicular cyst (n = 26)	Total (n = 51)
Sex
	Female	17	16	33 (64.7%)
	Male	8	10	18 (35.3%)
Age
	≤ 40	12	18	30 (58.8%)
	> 40	13	8	21 (41.2%)
Anatomical location
	Maxilla	17	18	35 (68.6%)
	Mandible	8	8	16 (31.4%)
Symptomatology
	Asymptomatic	17	13	30 (58.8%)
	Symptomatic	8	13	21 (41.2%)
Size
	≤ 1 cm	18	9	27 (52.9%)
	> 1 cm	7	17	24 (47.1%)
Endodontic treatment
	Not treated	17	23	40 (78.4%)
	Treated	8	3	11 (21.6%)

Variables		ALDH-1 expression		p-value^* * Chi-square test.
Variables		Low expression n (%)	High expression n (%)	p-value^* * Chi-square test.
Lesion
	Radicular cyst	18 (72.0)	8 (30.8)	0.003
	Periapical granuloma	7 (28.0)	18 (69.2)	0.003
Sex
	Female	13 (52.0)	20 (76.9)	0.063
	Male	12 (48.0)	6 (23.1)	0.063
Age
	≤ 40	15 (60.0)	15 (57.7)	0.867
	> 40	10 (40.0)	11 (42.3)	0.867
Anatomical location
	Maxilla	17 (68.0)	18 (69.2)	0.920
	Mandible	8 (32.0)	8 (30.8)	0.920
Symptomatology
	Asymptomatic	13 (52.0)	17 (65.4)	0.332
	Symptomatic	12 (48.0)	9 (34.6)	0.332
Size
	≤ 1 cm	12 (48.0)	15 (57.7)	0.488
	> 1 cm	13 (52.0)	11 (42.3)	0.488
Endodontic treatment
	Not treated	22 (88.0)	18 (69.2)	0.103
	Treated	3 (12.0)	8 (30.8)	0.103

Variables		ALDH-1 expression		p-value
Variables		Low expression n (%)	High expression n (%)	p-value
Sex
	Female	3 (42.8)	14 (77.8)	0.156^* * Fisher's exact test.
	Male	4 (57.2)	4 (22.2)	0.156^* * Fisher's exact test.
Age
	≤ 40	5 (71.4)	12 (66.7)	1.000^* * Fisher's exact test.
	> 40	2 (28.6)	6 (33.4)	1.000^* * Fisher's exact test.
Anatomical location
	Maxilla	5 (71.4)	12 (66.7)	1.000^* * Fisher's exact test.
	Mandible	2 (28.6)	6 (33.4)	1.000^* * Fisher's exact test.
Symptomatology
	Asymptomatic	3 (42.8)	14 (77.8)	0.156^* * Fisher's exact test.
	Symptomatic	4 (57.2)	4 (22.2)	0.156^* * Fisher's exact test.
Size
	≤ 1 cm	5 (71.4)	13 (72.2)	1.000^* * Fisher's exact test.
	> 1 cm	2 (28.6)	5 (27.8)	1.000^* * Fisher's exact test.
Endodontic treatment
	Not treated	6 (85.7)	11 (61.1)	0.362^* * Fisher's exact test.
	Treated	1 (14.3)	7 (38.9)	0.362^* * Fisher's exact test.

Variables		ALDH-1 expression		p-value
Variables		Low expression n (%)	High expression n (%)	p-value
Sex
	Female	10 (55.5)	6 (75.0)	0.420^* * Fisher's exact test.
	Male	8 (44.5)	2 (25.0)	0.420^* * Fisher's exact test.
Age
	≤ 40	12 (66.7)	6 (75.0)	1.000^* * Fisher's exact test.
	> 40	6 (33.3)	2 (25.0)	1.000^* * Fisher's exact test.
Anatomical location
	Maxilla	12 (66.7)	6 (75.0)	1.000^* * Fisher's exact test.
	Mandible	6 (33.3)	2 (25.0)	1.000^* * Fisher's exact test.
Symptomatology
	Asymptomatic	10 (55.5)	3 (37.5)	0.673^* * Fisher's exact test.
	Symptomatic	8 (45.5)	5 (62.5)	0.673^* * Fisher's exact test.
Size
	≤ 1 cm	7 (38.9)	2 (25.0)	0.667^* * Fisher's exact test.
	> 1 cm	11 (61.1)	6 (75.0)	0.667^* * Fisher's exact test.
Endodontic treatment
	Not treated	16 (88.9)	7 (87.5)	1.000^* * Fisher's exact test.
	Treated	2 (11.1)	1 (12.5)	1.000^* * Fisher's exact test.

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[1] Corresponding Author: José Alcides Almeida de Arruda E-mail: alcides_almeida@hotmail.com