Dr. med. vet. Matthias Rinke, FTA Pathologie, FIATP...Dr. med. vet. Matthias Rinke, FTA Pathologie,...
Transcript of Dr. med. vet. Matthias Rinke, FTA Pathologie, FIATP...Dr. med. vet. Matthias Rinke, FTA Pathologie,...
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Dr. med. vet. Matthias Rinke, FTA Pathologie, FIATP
Histopathological evaluation of the teeth in regulatory studies: what are the needs
and what can we learn from it
TOX’2017 Magyar Toxikológusok Társasága
Tudományos konferencia Bükfürdő, Október 11-13.
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• Teeth represent not a standard protocol organ, not required by any guideline
• Considered as “by-product” when looked at slides of the nasal cavity
• Pathologists feel somewhat uncomfortable when gross lesions occur or teeth are target
• More focus on teeth due to increased investigation of anticancer compounds
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Overview of the Presentation: 1. Introduction
(Physiology/Anatomy/Histology)
2. Non-proliferative Lesions (Examples from ToxPath)
3. Proliferative Lesions (Terminology only)
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Embryology: Teeth formed by unique series of reciprocal inductive phenomena occurring between odontogenic epithelium and mesenchymal cells of the dental papilla and dental follicle
Crown formation: continuous process in rodent incisors: Inner dental epithelium induction of mesenchymal cells of dental papilla differentiation into odontoblasts dentin deposition reciprocal induction of inner dental epithelium differentiation into ameloblasts deposition of enamel
Root formation: Molar roots formed by Hertwig’s root sheath i.e.fusion of inner and outer dental epithelium
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Formation of Ameloblast (A) and Odontoblast (O) Layers, Mouse, longitudinal A
O
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Formation of Ameloblast and Odontoblast layers, longitudinal cut, Rat
A O
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Base of upper incisor, transverse cut (rat)
Courtesy of Dr. H. Ernst
A
O
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Neck region of upper incisor, transverse cut, Rat
Dentin
Enamel
Odontoblasts
Ameloblasts
Pulp
Courtesy of Dr. H. Ernst
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Rodents: Anatomy of the tooth
• Only permanent, no deciduous/temporary teeth • 1 incisor / 3 molars per quadrant 2 (I1/1,M3/3) =16 • Incisors: Continuous growth / wearing • Renewal within 40 to 50 days (rats)
35 to 45 days (mice)
• Malocclusion or fracture of teeth may accelerate growth by a factor of 2 - 3 !
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Tooth substance composed of:
• Enamel: 1% organic material (glycoproteins), 99% inorganic material (hydroxyapatite crystals) • Dentin:
~ 20% organic material (collagen,glycoproteins) ~ 80% inorganic material (hydroxyapatite)
• Mineral content of rat incisor (mg/g dry weight): Ca: 275, P: 140, Mg: 5.5, Na: 5.3, K: 2,6
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Decalcification:
EDTA (3 weeks +) Citric Formic Acid (2 weeks) Microwave (few days)
Disadvantage: loss of calculus, loss of enamel, tissue shrinkage and artifacts, suboptimal staining if over decalcified
- Plastic embedding - Precision cutting - Grinding methods Disadvantage: High costs
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Routine trimming of the nasal cavity*
* From: Brown R and JF Hardisty: Oral Cavity, Esophagus, and Stomach. In: Pathology of the Fischer Rat, Academic Press 1990
??
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Routine trimming of the nasal cavity*
Mouse, 3 levels
Rat, 3 - 4 levels
Rat, Level 1
Rat, Level 2
* From: Ruehl-Fehlert CI, B Kittel, G Morawietz et al.: Revised guides for organ sampling and trimming in rats and mice – Part 1 A joint publication of the RITA and NACAD groups, Exp Toxicol Pathol. 2003 Sep; 55(2-3):91-106
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Modified trimming of the nasal cavity / jaws
Transverse Section
Longitudinal Section
Additionally, one transverse section through the 2nd incisor of the lower jaw possible
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Modified trimming of the nasal cavity with incisors of the upper jaw
* From: Kuijpers MHM et al. (1996): The rat incisor in toxicologic pathology. Tox Path 24, 346 - 360
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A B C D E F G H
A Bone
B Vasculature C Periodontal Ligament D Ameloblasts E Enamel F Dentin G Odontoblasts H Pulp
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Congenital lesions:
• Ameloblast and odontoblast degeneration/necrosis • Tooth resorption • Attrition
Inflammatory and vascular lesions:
Degenerative lesions:
• Deviations from normal number or position, malocclusion
• Periodontal disease, pulpitis, dental abscesses, fistulae
Neoplastic lesions
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Non-neoplastic Terms Degeneration Necrosis Periodontal pocket Dentin niches Dentin, decreased Dentin matrix alteration Fracture Resorption Denticle(s) Pulp concretion Cyst(s) Thrombus
Actual INHAND Nomenclature Fossey S. et al. 2016, JTP 29, 3 (supplement)
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Supernumerary tooth
rat mouse
Courtesy of Dr. H. Ernst
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‘Root’ Resorption: perforation of dentine layer by inflammatory tissue
rat
Courtesy of Dr. H. Ernst
mouse
Dental cyst
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Dental folds
SGH
Courtesy of Dr. H. Ernst
Intrapulpal denticles
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Example 1: Antiparasitic compound, 13 weeks
Inlife observation: Accelerated growth of incisors Y-shaped growth Malocclusion or fracture of teeth may accelerate growth by factor of 2 - 3 !
Yellow color of teeth due to thin iron-containing layer.
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A. Normal appearance, upper jaw B. Proliferation of gingival epithelium and periodontal ligament, inflammation
A B
Example 1: Antiparasitic compound, rat, 13 weeks
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Example 1: Antiparasitic compound
A. Normal appearance of the gingiva and periodontal ligament, lower jaw B. Periodontal ligament proliferation, gingiva hyperplasia
A B
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Example 1: Antiparasitic compound
A. Gingivitis and hyperplasia B. Periodontal ligament proliferation, multifocal karyomegaly in cementoblast layer
A B
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Example 1: Antiparasitic compound
A. Normal appearance of ameloblast layer, mid part B/C. Atrophy and degeneration of ameloblast layer
B A
B
C
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Example 1: Antiparasitic compound, transverse, lower jaw
A B C D
Control Control
Mid Dose High Dose
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Example 2: Anticancer compound 1, rat, 4 weeks
A. Normal appearance B. Degeneration of odontoblasts and dentin matrix alteration
A B
Inlife Observation: Accelerated growth of incisors, fractures
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Example 2:
A. Normal appearance B/C. Degeneration of odontoblasts and dentin matrix alteration with pulp concretions (pulp stones)
A B C
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Example 2: Anticancer compound 1
A. Cystic lacunae formation within dentin, close to basis of incisor B. Accelarated growth, cellular remnants in normally acellular dentin
A B
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Example 2: Anticancer compound 1
A. Normal Appearance B. Penetration of periodontal ligament into dentin (Tooth resorption) C. „Fracture“ of cementum
A B C
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Example 3: Anticancer compound 2, mouse, 13 weeks
A. Altered dentin composition, hyperdentinosis B. Altered dentin, periodontal ligament and cementum within normal range C. Altered dentin, odontoblast and ameloblast layer without alterations
Inlife observation: Deformation and fracture of incisors
A B C
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A./B. Fracture and pulp necrosis – Attention: Septicemia possible
Inlife observation: Deformation and fracture of incisors
B A
Example 3: Anticancer compound 2, mouse, 13 weeks
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Example 4: Anticancer compound 3, rat, 13 weeks
A./B. Fracture and pulp necrosis, Necrosis of ameloblast layer
Inlife observation: Discoloration and occasional fracture of incisors
B
A
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Early changes of ameloblast layer vacuolization
Example 4: Anticancer compound 3, rat, 13 weeks
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Enamel defects and dentin matrix alterations
Example 4: Anticancer compound 3, rat, 13 weeks
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Degeneration of periodontal ligament
Example 4: Anticancer compound 3, rat, 13 weeks
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Severe vascular degeneration of dental growth zone
Example 4: Anticancer compound 3, rat, 13 weeks
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Degeneration of odontoblast layer and protrusion into dentin
Example 4: Anticancer compound 3, rat, 13 weeks
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Sequestration and production of dentin (denticles?) within pulp cavity
Example 4: Anticancer compound 3, rat, 13 weeks
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Early fractures with necrosis
Example 4: Anticancer compound 3, rat, 13 weeks
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Example 5: Anticancer compound 4, rat, 3d on 3d off 3d on
A. Necrosis of odontoblast layer at basis of odontogenic epithelium, d 3 B. Regeneration of odontoblast layer during drug holiday, d 6
B A
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A. Odontoblast degeneration, B. Pulp necrosis, loss of dentin
B A
Example 5: Anticancer compound 4, rat, 3d on 3d off 3d on
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A./B. Odontoblast degeneration and sequestration of dentin
B A
Example 5: Anticancer compound 4, rat, 3d on 3d off 3d on
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Neoplastic Terms Ameloblastoma (TgAC) Ameloblastic odontoma Odontogenic fibroma Odontoma (no tumor/hamartoma) Cementifying/ossifying fibroma Tumor, odontogenic, benign Tumor, odontogenic, malignant
Actual INHAND Nomenclature Fossey S. et al. 2016, JTP 29, 3 (supplement)
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What about Non-rodents and Relevance of Rodent Findings
for Humans?
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Dentition in Beagle dogs
Deciduous Teeth Permanent Teeth
Eruption on day Exfoliation on day Eruption on day
Incisors 23 – 25 (+/- 3) 114 - 133 (+/- 6) 115 – 133 (+/- 6)
Canines 21 – 22 (+/- 2) 140 – 160 (+/- 23) 146 (+/- 7)
Premolars - - I:106 (+/- 8)II-IV: 136 – 155 (+/- 6)
Molars 29 – 35 (+/- 4) 137 – 155 (+/- 7) 128 – 175 (+/- 7)
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Beagle dog: Trimming of the teeth / Upper jaw
Transverse Section
Longitudinal Section
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Example 6: Anticancer compound Beagle Dog, Age at study start 119 - 147 days, 4 wk + 4 wk Recovery Inlife Observations: none
A. Control, incisor, normal appearance, straight dentinal canaliculi B. Treated, incisor, altered dentin composition
B A
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Example 6: Anticancer compound, dog
A. Treated, incisor, base of tooth with altered dentin matrix (4 wk) B. Treated, progressed dentinal alteration, followed by normal growth (4 wk R)
B A
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Example 6: Anticancer compound, Beagle dog, 1 year
A. Control, incisor, normal appearance B. Treated, incisor, more or less normal, straight dentinal canaliculi
B
Inlife observation: persisting canines
A
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Example 6: Anticancer Compound 2, Beagle Dog, 1 year
A. Treated, found dead on day 232, incisor, undulated dentinal canaliculi B. Treated, same animal, canine tooth, altered dentin composition
B A
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Hypovitaminosis A Increased thickness of enamel covered dentinReduced thickness of cementum-covered dentinPulp invasion by odontogenic epithelium
Hypovitaminosis D Wide zone of predentin, marbled dentinhypocalcified cementum
Hypovitaminosis E Degeneration of enamel and fibrous replacement
Hypervitaminosis D Hypercalcified dentin and cementumOssification of periodontal membranes
Known reasons for incisor lesions:
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Ca and P Deficiency Wide zone of predentin Vascular inclusions in dentin
Mg Deficiency Disturbed dentin calcification (stratification) Enamel atrophy and hypoplasia
Fluorosis Disturbed dentin calcification Enamel hypoplasia
Tetracyclines Enamel defects Doxorubicin Necrosis of pulp mesenchyme and odontoblasts Adriamycin Necrosis of pulp mesenchyme and odontoblasts Cyclophosphamide Growth interruption, supernumerary teeth VEGF Inhibitors Tubulin Inhibitors
Degeneration/necrosis of odontoblasts Enamel hypoplasia and discoloration
Known reasons for incisor lesions:
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Rodent: Conclusions
• Unique model of dental pathological processes • Continuous growth and differentiation • Odontogenic tissue remains functional during life span • Sensitive recorder of altered mineral metabolism • Modify level 1 of the nasal cavity slide • Additional use of longitudinal cuts of the incisor of lower jaw is proposed
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Dog: Conclusions
• Sensitive recorder of altered mineral metabolism • Incisor teeth are easy to process • Always think of age of the animals and duration of study, renewal of the tooth takes some time
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