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. 2025 Apr 11;25(1):526.
doi: 10.1186/s12903-025-05845-2.

Histological and immunohistochemical analysis of human periapical lesions: a study of TGF-β1 and CD68 markers

Nermeen AbuBakr  1 , Geraldine M Ahmed  2 , Amany Hany Mohamed Kamel  3
Affiliations

Histological and immunohistochemical analysis of human periapical lesions: a study of TGF-β1 and CD68 markers

Nermeen AbuBakr et al. BMC Oral Health. .

Abstract

Background: Various inflammatory and anti-inflammatory mediators, along with diverse cell types, are implicated in the development and progression of periapical lesions. This work aimed to assess the immuno-expression of transforming growth factor-beta 1 (TGF-β1) and CD68 (a macrophage marker), elucidating their roles and potential correlations. Additionally, histological analysis was conducted to evaluate the intensity of inflammatory infiltrates in chronic periapical lesion samples.

Methods: Tissue samples from fifty individuals with chronic periapical lesions [25 radicular cysts (RCs) and 25 periapical granulomas (PGs)] were obtained, along with control samples from four healthy third molars' dental pulp. Histological examination and inflammatory infiltrate categorization were performed. Immunohistochemical analysis of TGF-β1 and CD68 markers, along with morphometric assessment, were conducted.

Results: The control group displayed normal, inflammation-free pulp tissues, while intense inflammation was observed in PGs and RCs (Score 4 and 3, respectively) dominated by macrophages, plasma cells, and lymphocytes. Immunohistochemistry showed higher TGF-β1 and CD68 expression in PGs and RCs versus control (P < 0.001). Moreover, PGs exhibited greater TGF-β1 and CD68 expression than RCs (P < 0.001). However, a negative relationship was detected between the 2 markers (P < 0.05).

Conclusions: This study highlighted varying expressions of TGF-β1 and CD68 in PGs and RCs, indicating their potential roles in lesion pathology. However, a negative correlation between these markers was observed. Accordingly, their precise role in periapical lesion progression and repair requires further investigation.

Keywords: Immunohistochemistry; Inflammation; Macrophages; Periapical granuloma; Radicular cyst.

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Conflict of interest statement

Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: Ethical approval for this study was granted by the Institutional Ethical Committee of the Faculty of Dentistry, Cairo University (Approval no. 16/10/21), in line with the guidelines set forth in the Declaration of Helsinki. Informed consent was acquired from all participating patients before sample collection, following a thorough explanation of the study’s goals, procedures, and any potential discomforts and risks.

Figures

Fig. 1
Fig. 1
Representative histological photomicrographs using H&E staining. a, d. Healthy pulp tissues showing normal histology without any noticeable inflammatory cell infiltration. b, e. Radicular cyst revealing numerous inflammatory cell infiltration (orange arrows) & thin-walled dilated blood vessels (red arrows). c, f. Periapical granuloma displaying numerous inflammatory cell infiltration (orange arrows), fibroblasts (blue arrows) & plasma cells (red arrows) (a-c Orig. Mag. × 100; d-f Orig. Mag. × 400)
Fig. 2
Fig. 2
Representative photomicrographs of immunohistochemical staining of TGF-β1. a, d. weak staining in healthy pulp tissue; b, e. intense staining in radicular cyst; c, f. intense staining in periapical granuloma (a-c Orig. Mag. × 100; d-f Orig. Mag. × 400)
Fig. 3
Fig. 3
Representative photomicrographs of immunohistochemical staining of CD68 + cells. a, d. weak staining in healthy pulp tissue; b, e. intense staining in radicular cyst; c, f. intense staining in periapical granuloma (a-c Orig. Mag. × 100; d-f Orig. Mag. × 400)
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