Análise epidemiológica e da resposta imune periapical em pacientes pré e pós transplante de células tronco hematopoiéticas e de fígado portadores de infecções endodônticas

Abstract

Pulpo-periapical pathologies cover many areas of knowledge, including epidemiology, microbiology and immunology. Literature lacks of studies about main disease that lead to hematopoietic stem cell transplant interference and their treatment. Hematopoietic Stem Cell Transplant (HSCT) involves high dose chemotherapy with or without full body radiotherapy ablation of abnormal or malignant cells, leading patient to a immunosuppression state. Liver diseases are a very common health matter, and the main underlying causes include infections, alcohol abuse and lipid and carbohydrate metabolic disorders. Those conditions make the subject more susceptible to infections, provoking considerable morbidity or even death. In this work, 188 pre and post transplant (TCTH) individuals and 120 pre liver transplant subjects were selected. Patients personal and systemic data were correlated with endodontic treatment need. Subjects that needed endodontic treatment had the root canals of those teeth analyzed for their immunological profile. Healty individuals (that needed endodontic therapy) were selected as controls for comparison. Samples were collected at two times points, immediately after cleaning and shaping the root canal system and 7 days later. Using Real Time PCR, we evaluated the cytokines and chemokines expression of TNF-, IL-1, IL- 10, IFN-, IL-6, CCL2, CCL4, CXCR4, VEGF angiogenic factors and angiopoietin. In the TCTH group, most individuals showed platelets and hemoglobin values bellow reference values before transplant. Furthermore, most HSCT pre transplant patients exhibited platelet and red blood cells counts below the reference values at first appointment time. Most of the analyzed patients used some medication, being 75.5% and 92.5%, at TCTH and TF groups, respectively. Antibiotics were taken by 32% and 51.8% of pre and post TCTH pacients whilst diuretics represent most taken medication by pre TF patients (90.8%). It was attested endondontic treatment need, in pre e post TCTH patients, of 24.3% e 24.7% respectively. Endondontic treatment need observed in pre TF patients was 20.7%. Comparing pre TCTH patients com with control, the results regarding chetokines and chemokines expression were: significantly increased expression levels of TNF- and IFN- on day 7; the mRNA levels of IL-1- and IL-10 in the 18 bone marrow group increased in the samples from day 7; chemokine receptor CXCR4 levels increased in samples obtained from the day 7 control group; the chemokine CCL-2/MCP-1 was not detected in patients undergoing HSCT. Comparing pre TF patients with control, regarding cytokines, chemokines and angiogenic factors expression were: in control/ health group, a significantly increased expression of proinflammatory cytokines IFN- and TNF- was observed in teeth with restrained bacterial loads (day 7); larger expression of TNF- at day 7 were also observed in the TF group; significant increase in mRNA levels of AGT in teeth with restrained bacterial load (day 7) compared to the first collection in control individuals. It can be concluded that: a) The percentage of individuals with endodontic treatment need is high at all astudied groups; b) Most of the analysed patients used some medication being antibiotics most used drug in TCTH group whilst diuretics represent the most used medicine in TF group; c) Pre TCTH and pre TF individuals, mostly present low blood cell count what can be related to these patients immune depression; d) Genic chemokine and cytokine expression showed that pre TCTH patients have a pro and anti-inflammatory efficient response, similar to control and e) Genic chemokine, cytokine, and angiogenic expression suggest that liver impairment did not compromise periapical immune response once a similar response was observed in control.