Oral cancer stem cells - properties and consequences

Research on cancer stem cells (CSCs) has greatly increased in the field of medicine and pathology; however, some conceptual misunderstandings are still present among the public as well as within the general scientific community that is not yet familiar with the subject. The very first problem is the misinterpretation of CSCs as a synonym of their normal counterparts, the well-known stem cells (SCs). Particularly in Dentistry, another common mistake is the misinterpretation of oral CSCs as normal tooth-derived SCs. The present review aims to clarify important concepts related to normal SCs and CSCs, as well as discuss the relevance of CSCs to the development, metastasis and therapy resistance of oral squamous cell carcinoma

Localização de transcritos de Bmp-4, Shh e Wnt-5a durante as fases iniciais do desenvolvimento dentário de camundongos por hibridização in situ

A comparative nonisotopic in situ hybridization (ISH) analysis was carried out for the detection of Bmp-4, Shh and Wnt-5a transcripts during mice odontogenesis from initiation to cap stage. Bmp-4 was expressed early in the epithelium and then in the underlying mesenchyme. Shh expression was seen in the odontogenic epithelial lining thickening, being stronger in the enamel knot area, during the cap stage. Wnt-5a transcripts were expressed only in the mesenchyme during the initiation, bud and cap stages, with strong expression in the dental mesenchyme during the bud stage. The present results showed that Bmp-4, Shh and Wnt-5a are expressed since the very early stages of tooth development, and they suggest that the Wnt-5a gene is expressed in different cell populations than Bmp-4 and Shh.No presente trabalho, realizou-se uma análise comparativa não isotópica por hibridização in situ a fim de se detectar a presença de transcritos de Bmp-4, Shh e Wnt-5a durante as fases iniciais da odontogênese em camundongos, desde a iniciação até o estágio de capuz. No estágio de iniciação, observou-se expressão precoce de Bmp-4 no epitélio e no mesênquima subjacente, enquanto que a expressão de Shh ocorreu durante o estágio de capuz, na região de espessamento do revestimento epitelial odontogênico, tornando-se mais intensa na área de nó do esmalte. Os transcritos de Wnt-5a foram expressos somente no mesênquima durante os estágios de iniciação, botão e capuz, com intenso sinal na região no mesênquima na fase de botão. Estes resultados mostraram que Bmp-4, Shh e Wnt-5a são expressos desde os estágios mais precoces do desenvolvimento dentário, sugerindo que o gene Wnt-5a seja expresso em populações celulares distintas daquelas que expressam Bmp-4 e Shh.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)University of São Paulo School of Dentistry Department of Oral PathologyUniversity of São Paulo Biomedical Sciences Institute Department of ImmunologyFederal University of São Paulo Center for Development of Animal ModelsUNIFESP, Center for Development of Animal ModelsSciEL

Rat subcutaneous tissue response to MTA Fillapex® and Portland cement

The aim of this study was to evaluate the response of rat subcutaneous tissue to MTA Fillapex® (Angelus), an experimental root canal filling material based on Portland cement and propylene glycol (PCPG), and a zinc oxide, eugenol and iodoform (ZOEI) paste. These materials were placed in polyethylene tubes and implanted into the dorsal connective tissue of Wistar rats for 7 and 15 days. The specimens were stained with hematoxylin and eosin, and evaluated regarding inflammatory reaction parameters by optical microscopy. The intensity of inflammatory response against the sealers was analyzed by two blinded and previously calibrated examiners for all experimental periods (kappa=0.96). The histological evaluation showed that all materials caused a moderate inflammatory reaction at 7 days, which subsided with time. A greater inflammatory reaction was observed at 7 days in the tubes filled with ZOEI paste. Tubes filled with MTA Fillapex presented some giant cells, macrophages and lymphocytes after 7 days. At 15 days, the presence of fibroblasts and collagen fibers was observed indicating normal tissue healing. The tubes filled with PCPG showed similar results to those observed in MTA Fillapex. At 15 days, the inflammatory reaction was almost absent at the tissue, with several collagen fibers indicating normal tissue healing. Data were analyzed by the nonparametric Kruskal-Wallis test (?=0.05). Statistically significant difference (p<0.05) was found only between PCPG at 15 days and ZOEI at 7 days groups. No significant differences were observed among the other groups/periods (p>0.05). MTA Fillapex and Portland cement added with propylene glycol had greater tissue compatibility than the PCPG paste.O objetivo deste estudo foi avaliar a resposta do tecido subcutâneo de rato ao MTA Fillapex® (Angelus), a um cimento endodôntico experimental à base de cimento Portland e propilenoglicol, e à pasta de óxido de zinco e eugenol com iodofórmio. Estes materiais foram colocados em tubos de polietileno e implantados no tecido conjuntivo do dorso de ratos Wistar, por 7 e 15 dias. Os espécimes foram corados com hematoxilina e eosina e os parâmetros de reação inflamatória foram avaliados em microscópio óptico. A intensidade da resposta inflamatória provocada pelos cimentos foi analisada em todos os períodos por dois observadores previamente calibrados (kappa 0,96) e sem conhecimento dos grupos experimentais. O exame histológico mostrou que todos os materiais provocaram reação inflamatória moderada aos 7 dias que regrediu com o tempo. A maior resposta inflamatória do tecido foi observada aos 7 dias, nos tubos preenchidos com pasta de Óxido de Zinco e Eugenol com Iodofórmio. Os tubos com MTA Fillapex apresentaram algumas células gigantes, macrófagos e linfócitos após 7 dias. Aos 15 dias, a presença de fibroblastos e fibras de colágenas foi observada, indicando processo de cicatrização do tecido. Os tubos com o cimento Portland mostraram resultados semelhantes aos observados no grupo MTA Fillapex. Aos 15 dias, a reação inflamatória apresentada foi praticamente ausente, com muitas fibras colágenas, indicando cicatrização normal do tecido. A análise estatística mostrou diferença estatisticamente significante entre o grupo de cimento Portland (15 dias) e óxido de zinco eugenol com Iodofórmio (7 dias) (p<0,05). Nos outros grupos não houve diferença estatística significante. MTA Fillapex e cimento Portland são mais biocompatíveis do que os outros cimentos testados

Initial inflammatory response after the pulpotomy of rat molars with MTA or ferric sulfate

Purpose: To compare, both qualitatively and quantitatively, the inflammatory cells, vascular density and IL-6 immunolabeled cells present in the pulp after pulpotomy with white MTA versus 15.5% ferric sulfate (FS). Methodology: Forty-eight mandibular first molars from 24 Wistar rats were divided into MTA or FS groups and subdivided according to the period after pulpotomy procedure (24, 48 and 72 hours). Four teeth (sound and untreated) were used as controls. Histological sections were obtained and assessed through the descriptive analysis of morphological aspects of pulp tissue and the quantification of inflammatory cells, vascular density and interleukin-6 (IL-6) expression. Data were statistically analyzed (p&lt;0.05). Results: The number of inflammatory cells was similar in both groups, being predominantly localized at the cervical radicular third. In the MTA group, increased inflammation was observed at 48 hours. Vascular density was similar in both groups and over time, being predominant in the medium radicular third. No correlation was found between the number of inflammatory cells and the vascular density. Pulp tissue was more organized in MTA-treated teeth. In both groups, a weak to moderate IL-6 expression was detected in odontoblasts and inflammatory cells. Comparing both groups, there was a greater IL-6 expression in the cervical radicular third of teeth treated with MTA at 24 hours and in the medium and apical thirds at 72 hours, while in the FS group a greater IL-6 expression was found in the apical third at 24 hours. Conclusion: The MTA group presented better histological features and greater IL-6 expression than the FS group. However, no difference was observed between the groups regarding the inflammatory status and vascularization, suggesting the usefulness of FS as a low-cost alternative to MTA

Doença periodontal inflamatória induzida por ligadura: Caracterização microscópica e estudo da presença de mastócitos e das enzimas óxido nítrico sintase induzível (iNOS) e metaloproteinases -2 e -9

A doença periodontal inflamatória envolve mecanismos imunopatológicos e inflamatórios contra microrganismos da placa dentobacteriana, sendo que diversas células, tanto residentes quanto inflamatórias, e mediadores químicos participam ativamente da resposta do hospedeiro. O presente trabalho teve como objetivo caracterizar o modelo experimental da doença periodontal inflamatória induzida por ligadura em ratos, com ênfase na avaliação clínica e microscópica, bem como no estudo quantitativo dos mastócitos e da presença de RNA mensageiro (RNAm) codificador das enzimas óxido nítrico sintase induzível (iNOS) e metaloproteinases (MMPs) -2 e 9. Para este fim, as amostras correspondentes foram obtidas em diferentes períodos de indução da doença periodontal inflamatória experimentalmente induzida (1, 3, 7, 14, 28, 42 e 56 dias ou 1, 3, 7, 14 e 30 dias) e avaliadas microscopicamente por meio das colorações de hematoxilina-eosina e azul de toluidina, bem como semi-quantitativamente por meio de Reação em Cadeia da Polimerase precedida por Transcrição Reversa (RT-PCR). Para fins comparativos, foram utilizadas amostras de tecido gengival normal do mesmo animal. Microscopicamente, observou-se exuberante presença de polimorfonucleares (PMNs) nos tecidos afetados pela doença periodontal inflamatória, especialmente nos períodos inicias. Detectou-se ainda a expressão aumentada de RNAm para MMP-9 apenas nos tecidos afetados pela doença periodontal nos períodos de 3 e 7 dias, porém não se observou aumento estatisticamente significativo na expressão de RNAm para MMP-2 em nenhuma das comparações analisadas. Com relação à iNOS, a expressão de seu RNAm foi maior nos tecidos doentes quando comparados com os tecidos gengivais controle no período de 3 dias, assim como nos tecidos afetados pela doença periodontal no período de 3 dias ao se comparar com os tecidos doentes aos 7 dias após a indução. Ainda, o número de mastócitos/mm2 na região adjacente aos epitélios sulcular e juncional, bem como na área de inserção conjuntiva, apresentou-se diminuído na doença periodontal inflamatória experimentalmente induzida em ratos, com relação aos tecidos gengivais saudáveis, tanto no lado vestibular quanto no lingual. Nossos resultados sugerem que a doença periodontal experimentalmente induzida em ratos caracteriza-se por lesões inflamatórias com predomínio de células PMNs e áreas de reabsorção óssea alveolar desde as primeiras 24 horas após a indução, porém sem progressão para um infiltrado inflamatório linfoplasmocitário organizado focalmente que caracteriza a doença humana. Provavelmente, a MMP-9 e o óxido nítrico (NO) têm participação na evolução e patogênese da doença periodontal experimentalmente induzida por ligadura, incluindo destruição tecidual e perda óssea alveolar. De forma contrária, os mastócitos parecem ter limitada participação na referida doença, não constituindo, provavelmente, fonte significativa da iNOS e da MMP-9.Inflammatory periodontal disease envolves imunopathological and inflammatory mechanisms against bacterial dental plaque, including the participation of host resident as well as inflammatory cells and chemical mediators. The present work characterized a ligature-induced model of experimental inflammatory periodontal disease, emphasysing clinical and microscopic valuation as well as quantitative study of the number of mast cells and the presence of expression of mesanger RNA (mRNA) of inducible nitric oxide (iNOS) and metalloproteinases (MMPs) -2 and -9. Samples were obtained from different periods and microscopically analysed trough hematoxylin-eonin and toluidin blue stainings, and quantitatively estimated through Reverse Transcriptase Polimerase Chain Reaction (RT-PCR). The results revealed the presence of numerous polymorphonuclear (PMN) cells on tissues affected by inflammatory periodontal disease, mainly on initial periods. Significant expression of MMP-9 was still detected on tissues affected by inflammatory periodontal disease on day 3 and 7, with no significant difference on the expression of MMP-2. iNOs expression was also higher on diseased tissues compared to controls on day 3 and between days 3 and 7 diseased tissues themselves. Mast cells numbers were reduced on the dentogengival area of diseased tissues compared to controle ones, on buccal and ligual sides. Our results suggest that experimentally induced inflammatory periodontal disease are characterized by inflammatory lesions with the predominance of PMNs and bone resorption areas since the first day of induction, although without a progression to a lymphocyte / plasma cells inflammatory infiltrate characteristic of human disease. Probably, MMP-9 and iNOS participate on the evolution and pathogenesis of ligature-induced periodontal disease, including tissue destruction and alveolar bone resorption. On the other hand, mast cells seem no to be a significant source of iNOS and MMP-9

Homeobox genes transcripts expression in oral squamous cell carcinoma: microarray analysis, qRT-PCR validation and association with clinical criteria of aggressiveness

A busca de marcadores moleculares para o refinamento diagnóstico, classificação e estabelecimento do prognóstico dos tumores, e individualização terapêutica tem sido foco de várias pesquisas. O presente estudo teve como objetivo investigar, em carcinoma epidermóide de língua e/ou assoalho bucal, a presença de transcritos dos genes homeobox que pudessem se revelar marcadores moleculares de prognóstico e/ou agressividade tumoral. Após análise por microarray utilizando-se amostras de tumores e margens classificados como mais e menos agressivos, os genes homeobox HOXC13, HOXD10, HOXD11, IRX4, PROX1 e ZHX1 foram selecionados e sua hiper-expressão foi parcialmente validada por qRT-PCR. Observou-se aumento da expressão de HOXD10, HOXD11 e IRX4 em tumores com relação às margens correspondentes, bem como nos tumores menos agressivos em relação às suas respectivas margens. Por outro lado, os genes PROX1 e ZHX1 estavam mais expressos nas margens que nos tumores correspondentes. Esses resultados sugerem que a expressão alterada de HOXD10, HOXD11 e IRX4 pode participar no desenvolvimento do carcinoma epidermóide de língua e/ou assoalho bucal, enquanto os genes PROX1 e ZHX1 provavelmente exibem perda de função ou estão silenciados na neoplasia. Houve uma tendência de associação entre a expressão elevada de HOXD11 e presença de infiltrações linfática e perineural, e grau moderado de diferenciação da neoplasia, bem como entre a expressão elevada de HOXD10 e infiltração linfática. O gene IXR4 foi relacionado com um menor tempo de sobrevida global. Não foi possível estabelecer, dentre os genes homeobox validados por qRT-PCR, um gene ou uma combinação deles que pudesse(m) ser utilizado(s) como marcador(es) de agressividade tumoral.The search for molecular markers to diagnosis improvement, treatment individualization and establishment of oral squamous cell carcinoma prognosis has been the focus of several studies. The present study investigated the presence of specific transcript of homeobox genes in squamous cell carcinoma of the tongue and/or floor of the mouth that might reflect relevant molecular markers of prognosis and/or tumor aggressiveness. After microarray analysis of tumor samples classified as more or less aggressive, and non tumoral margins, HOXC13, HOXD10, HOXD11, IRX4, PROX1 and ZHX1 selected and partially validated by qRT-PCR. Increased expression of HOXD10, HOXD11, IRX4 in tumors in comparison to margins as well as in less aggressive tumors related to their margins was observed. On the other hand, a decreased expression of PROX1 and ZHX1 was observed in margins compared to their respective tumors. These results suggest that the altered expression of HOXD10, HOXD11 and IRX4 may participate in the development of squamous cell carcinoma of the tongue and/or floor of the mouth, while PROX1 and ZHX1 probably present loss of function or are silenced in tumors. A tendency of association between increased expression of HOXD11 and lymphatic and perineural infiltration, as well as moderately differentiated tumors, and increased expression of HOXD10 and lymphatic infiltration was observed. Still, increased expression of IRX4 may apparently influence global survival rate. However, the results of the present study must be confirmed in a greater number of samples, and complemented with the evaluation of HOXD10, HOXD11, IRX4 protein levels. It was not possible to establish, among homeobox genes validated through qRT-PCR, a gene or a combination of genes capable of predicting tumor aggressiveness

Possible role of ALDH1 and CD44 in lip carcinogenesis

Abstract Lip squamous cell carcinoma (LSCC) accounts for 12% of all head and neck cancers. It is caused by chronic exposure to ultraviolet light solar radiation and related to previous actinic cheilitis (AC). This study aimed to investigate the immunostaining of the putative cancer stem cells (CSC) markers ALDH1 and CD44 in AC (n=30) and LSCC (n=20). ALDH1 positivity was found to be statistically higher in LSCC than in AC lesions (p=0.0045), whilst CD44 expression was statistically higher in AC than in LSCC lesions (p=0.0155). ALDH1+ cells in AC lesions were associated with specific clinical features: a younger age (<60 years old), the female gender, white skin, not smoking or consuming alcohol, and a fast evolution, and not associated with the chronic exposure to UV radiation (p<0.0001). CD44 positivity was associated with patients who were male, feoderm, smoked, consumed alcohol, underwent occupational exposure to UV-radiation, and demonstrated lesions with log-time evolution (p<0.0001). ALDH1 + cells were associated with mild dysplasia using a system from the World Health Organization (WHO), and with a low risk of malignant transformation, according to the binary system (p<0.0001). CD44+ cells were also associated with moderated dysplasia, according to the WHO system. In LSCC, ALDH1 + cells were positively associated with patients who were older (≥ 60 years old), smokers, and with those who consumed alcohol (p<0.0001). CD44 + cells in LSCC were associated with older (≥ 60 years old) patients as well, but also with female patients, white skin, non-smokers, and individuals who did not consume alcohol (p<0.0001), all of whom showed distinct patterns in pre- and malignant lesions of both markers. Additionally, in LSCC, both ALDH1 and CD44 staining were associated with smaller tumor sizes (T1/T2; p<0.0001). In summary, although both ALDH1 and CD44 were associated with the presence of dysplasia in AC lesions, the present findings suggest that ALDH1 and CD44 may be activated by different etiopathogenic pathways, predominantly in distinct steps of oral carcinogenesis. CD44 would thus be more significantly related to the potentially malignant lesion, while ALDH1 would be closely linked to malignancy

Journal of Oral Pathology and Medicine

Trabalho completo: acesso restrito, p. 708–715Oncogenic Wnt/b-catenin signaling occurs in numerous types of cancers, but little is known about the role of the Wnt protein family member, WNT- 5A, in lip carcinogenesis. The aim of this study was to investigate WNT-5A, b-catenin, and matrix metalloproteinase (MMP)-3 protein expression in actinic cheilitis (AC), and lip squamous cell carcinoma (LSCC). METHODS: Twenty-one cases of AC, and fifty-one cases of LSCC were analyzed, with normal lip mucosa used as a control. Qualitative and semi-quantitative analyses of WNT-5A, b-catenin, and MMP-3 immunostaining pattern and cellular distribution were performed. RESULTS: WNT-5A was observed in more than 50% of the cells, scattered in all layers of AC, in contrast to the absence of immunostaining in normal lip mucosa. AC presented a higher level of WNT-5A expression than LSCC (P = 0.0289, Fisher test), while MMP-3 immunoexpression was statistically more significant in LSCC than in AC (P = 0.0285, Fisher test). Immunolabeling of b-catenin protein was differentially distributed between samples; the majority of AC cases (61.90%) demonstrated a membranous-cytoplasmic pattern, while a considerable number of LSCC cases (29.41%) revealed a cytoplasmic pattern, instead of the usual membranous pattern. CONCLUSIONS: The present results suggest that WNT-5A may be an important marker during initial events of AC malignant transformation, in which noncanonical and canonical Wnt/b-catenin signaling pathways could be involved. Additionally, WNT-5A might recruit other events in LSCC, such as MMP-3 protein synthesis, as its presence is increased in established malignant processes without b-catenin dependency

Mechanisms involved in cancer stem cell resistance in head and neck squamous cell carcinoma

Despite scientific advances in the Oncology field, cancer remains a leading cause of death worldwide. Molecular and cellular heterogeneity of head and neck squamous cell carcinoma (HNSCC) is a significant contributor to the unpredictability of the clinical response and failure in cancer treatment. Cancer stem cells (CSCs) are recognized as a subpopulation of tumor cells that can drive and maintain tumorigenesis and metastasis, leading to poor prognosis in different types of cancer. CSCs exhibit a high level of plasticity, quickly adapting to the tumor microenvironment changes, and are intrinsically resistant to current chemo and radiotherapies. The mechanisms of CSC-mediated therapy resistance are not fully understood. However, they include different strategies used by CSCs to overcome challenges imposed by treatment, such as activation of DNA repair system, anti-apoptotic mechanisms, acquisition of quiescent state and Epithelial-mesenchymal transition, increased drug efflux capacity, hypoxic environment, protection by the CSC niche, overexpression of stemness related genes, and immune surveillance. Complete elimination of CSCs seems to be the main target for achieving tumor control and improving overall survival for cancer patients. This review will focus on the multi-factorial mechanisms by which CSCs are resistant to radiotherapy and chemotherapy in HNSCC, supporting the use of possible strategies to overcome therapy failure

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology

Acesso restrito: Texto completo. p. 403-410Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor associated with aggressive clinical behavior, metastasis, and low survival. We report a case of CCOC affecting the mandible of a 39-year-old man. The tumor presented a biphasic pattern composed of clear cell nests intermingled with eosinophilic cells and separated by collagenous stroma. Immunoreactivity to cytokeratin (CK), specifically AE1/AE3 and CK 8, 14, 18, and 19 was found, as well as to epithelial membrane antigen (EMA). The tumor cells were negative for S100 protein, CK 13, vimentin, smooth muscle actin, laminin and type IV collagen. Low labeling indices for the proliferation markers Ki-67 and proliferating cell nuclear antigen and to p53 protein might predict a favorable prognosis for the lesion. A surgical resection was performed, followed by adjuvant radiotherapy. A 2-year follow-up has shown no signs of recurrence. The significance of histochemical and immunohistochemical resources in the correct diagnosis of CCOC is analyzed. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:403-10